Systemic to Pulmonary Shunt Techniques in Cyanotic Congenital Heart Disease Patients: An Analysis of 24 Years of Clinical Experience

Burcu Bıçakhan; Aybala Tongut; İlhan Özgöl; Alican Hatemi

Makale detayları

Systemic to Pulmonary Shunt Techniques in Cyanotic Congenital Heart Disease Patients: An Analysis of 24 Years of Clinical Experience

Yazarlar:

Burcu Bıçakhan | Aybala Tongut | İlhan Özgöl | Alican Hatemi

Yayıncı:

Dokuz Eylul University

Ana Başlıklar:

Cerrahi

Dergi:

Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi Vol.37 Issue 2, pp.173-189

Belge Tipi:

Makale

Yayın Tarihi:

6/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001298039

pISSN:

2602-3148

Anahtar kelimeler:

Özet:

 Purpose: Aortopulmonary shunt operations are palliative interventions that are used in complex cyanotic cardiac conditions to improve systemic oxygen saturation and maturating pulmonary arteries by increasing pulmonary blood flow. In this study, we aimed to investigate and evaluate the association between preoperative conditions, operative techniques, and postoperative outcomes; as well as to determine the risk factors that are related to morbidity, and mortality in patients receiving palliative aortopulmonary shunt procedures. Material and methods: Five hundred eighty-seven patients who underwent MBTS operation in Istanbul University, Institute of Cardiology, Department of Cardiovascular Surgery between November 1985  August 2009 were included in the study. Preoperative and postoperative data were examined, and patients were retrospectively grouped into two, regarding their pathology for either univentricular, or biventricular repair. Primary outcome was investigated as means of in-hospital death, or being discharged in good health. Three age groups neonatal, 1 month-1 year, older than 1 year, and two surgical technique groups thoracotomy, sternotomy were established to determine their effects on primary outcomes. Risk factors for mortality and morbidity were statistically analyzed. Results: Among the 587 patients enrolled, 364 were male 62, and 223 were female 38. Average age and body weights were 21,631,2 months 0-240 months, and 10,77,2 kg 2,754 kg, respectively. Age groups were as follows: 66 were under 1 month 11,2, 236 were between 1 month and 1 year 40,2, 285 were over 1 year 48,6. One hundred ninety-one cases 32,5 underwent univentricular repair, and biventricular repair procedure was planned for the remaining 396 patients 67,5. Median sternotomy was the approach preferred for 141 patients 24 and thoracotomy for the other 446 76. Early mortality rates were calculated as 11,6. Age, diagnosis, use of ECC, surgical approach and shunt diameter were found to be important risk factors for shunt failure. Among those, only surgical approach was found to be an independent risk factor according to multi-variate logistic regression analysis p0,002. Among mortality factors found to be statistically significant such as age, shunt diameter, and surgical technique, only sternotomy p0,0001 and being between 1month  1 year of age p0,008 were considered to be independent risk factors. Conclusion: In complex congenital heart defects, palliative surgical treatment seems to be the primary approach due to lack of alternatives. Today, there is an extensive experience on MBTS procedure and on its intensive care follow up protocools but there is still a need for long term prospective trials to establish the risk factors affecting mortality, and morbidity.

 Purpose: Aortopulmonary shunt operations are palliative interventions that are used in complex cyanotic cardiac conditions to improve systemic oxygen saturation and maturating pulmonary arteries by increasing pulmonary blood flow. In this study, we aimed to investigate and evaluate the association between preoperative conditions, operative techniques, and postoperative outcomes; as well as to determine the risk factors that are related to morbidity, and mortality in patients receiving palliative aortopulmonary shunt procedures. Material and methods: Five hundred eighty-seven patients who underwent MBTS operation in Istanbul University, Institute of Cardiology, Department of Cardiovascular Surgery between November 1985  August 2009 were included in the study. Preoperative and postoperative data were examined, and patients were retrospectively grouped into two, regarding their pathology for either univentricular, or biventricular repair. Primary outcome was investigated as means of in-hospital death, or being discharged in good health. Three age groups neonatal, 1 month-1 year, older than 1 year, and two surgical technique groups thoracotomy, sternotomy were established to determine their effects on primary outcomes. Risk factors for mortality and morbidity were statistically analyzed. Results: Among the 587 patients enrolled, 364 were male 62, and 223 were female 38. Average age and body weights were 21,631,2 months 0-240 months, and 10,77,2 kg 2,754 kg, respectively. Age groups were as follows: 66 were under 1 month 11,2, 236 were between 1 month and 1 year 40,2, 285 were over 1 year 48,6. One hundred ninety-one cases 32,5 underwent univentricular repair, and biventricular repair procedure was planned for the remaining 396 patients 67,5. Median sternotomy was the approach preferred for 141 patients 24 and thoracotomy for the other 446 76. Early mortality rates were calculated as 11,6. Age, diagnosis, use of ECC, surgical approach and shunt diameter were found to be important risk factors for shunt failure. Among those, only surgical approach was found to be an independent risk factor according to multi-variate logistic regression analysis p0,002. Among mortality factors found to be statistically significant such as age, shunt diameter, and surgical technique, only sternotomy p0,0001 and being between 1month  1 year of age p0,008 were considered to be independent risk factors. Conclusion: In complex congenital heart defects, palliative surgical treatment seems to be the primary approach due to lack of alternatives. Today, there is an extensive experience on MBTS procedure and on its intensive care follow up protocools but there is still a need for long term prospective trials to establish the risk factors affecting mortality, and morbidity.

 Purpose: Aortopulmonary shunt operations are palliative interventions that are used in complex cyanotic cardiac conditions to improve systemic oxygen saturation and maturating pulmonary arteries by increasing pulmonary blood flow. In this study, we aimed to investigate and evaluate the association between preoperative conditions, operative techniques, and postoperative outcomes; as well as to determine the risk factors that are related to morbidity, and mortality in patients receiving palliative aortopulmonary shunt procedures. Material and methods: Five hundred eighty-seven patients who underwent MBTS operation in Istanbul University, Institute of Cardiology, Department of Cardiovascular Surgery between November 1985  August 2009 were included in the study. Preoperative and postoperative data were examined, and patients were retrospectively grouped into two, regarding their pathology for either univentricular, or biventricular repair. Primary outcome was investigated as means of in-hospital death, or being discharged in good health. Three age groups neonatal, 1 month-1 year, older than 1 year, and two surgical technique groups thoracotomy, sternotomy were established to determine their effects on primary outcomes. Risk factors for mortality and morbidity were statistically analyzed. Results: Among the 587 patients enrolled, 364 were male 62, and 223 were female 38. Average age and body weights were 21,631,2 months 0-240 months, and 10,77,2 kg 2,754 kg, respectively. Age groups were as follows: 66 were under 1 month 11,2, 236 were between 1 month and 1 year 40,2, 285 were over 1 year 48,6. One hundred ninety-one cases 32,5 underwent univentricular repair, and biventricular repair procedure was planned for the remaining 396 patients 67,5. Median sternotomy was the approach preferred for 141 patients 24 and thoracotomy for the other 446 76. Early mortality rates were calculated as 11,6. Age, diagnosis, use of ECC, surgical approach and shunt diameter were found to be important risk factors for shunt failure. Among those, only surgical approach was found to be an independent risk factor according to multi-variate logistic regression analysis p0,002. Among mortality factors found to be statistically significant such as age, shunt diameter, and surgical technique, only sternotomy p0,0001 and being between 1month  1 year of age p0,008 were considered to be independent risk factors. Conclusion: In complex congenital heart defects, palliative surgical treatment seems to be the primary approach due to lack of alternatives. Today, there is an extensive experience on MBTS procedure and on its intensive care follow up protocools but there is still a need for long term prospective trials to establish the risk factors affecting mortality, and morbidity.

 Amaç: Aortopulmoner şant operasyonları, kompleks siyanotik kalp hastalıklarında pulmoner kan akımının arttırılması ve pulmoner arterlerin gelişmesi, dolayısı ile sistemik oksijen saturasyonunun iyileştirilmesini amaçlayan palyatif prosedürlerdir. Çalışmadaki amaç, palyatif aortopulmoner şant operasyonu uygulanan hastalarda preoperatif durum, operatif teknik ve yaklaşımlar ile postoperatif seyir arasındaki ilişkileri tespit etmek, mortalite ve morbiditeye etki eden risk faktörlerini araştırmak ve değerlendirmektir. Gereç ve yöntemler: Çalışmaya Kasım 1985-Ağustos 2009 tarihleri arasında İstanbul Üniversitesi Kardiyoloji Enstitüsü Kalp Damar Cerrahisi Anabilim Dalında Modifiye Blalock-Taussig şant MBTS operasyonu uygulanan 587 olgu dahil edildi. Retrospektif olarak preoperatif ve operatif veriler kaydedilerek, hastalar patofizyolojinin tek ya da çift ventrikül tamirine uygunluğu temel alınarak univentrikülbiventrikül iki grupta sınıflandırıldı. Birincil sonuç olarak hastane ölümü veya iyi hal ile taburcu olma kabul edildi. Yaş grupları neonatal, 1 ay-1 yaş ve 1 yaş üzeri ve cerrahi yaklaşım torakotomi, sternotomi temel alınarak, yaklaşımlar arasındaki farkların birincil sonuç üzerine etkisi değerlendirildi. Mortalite ve morbidite üzerine etki eden risk faktörleri istatistiksel olarak araştırıldı. Bulgular: Çalışmaya katılan 364ü erkek 62, 223ü kız 38, ortalama yaşı 21,631,2 ay 0-240 ve ortalama kilosu 10.77.2 kg 2.7-54 olan 587 hastanın, 66sı1 aylık 11.2, 236sı 1 ay-1 yaş 40.2 ve 285i 1 yaş üzeri 48.6 grupta değerlendirilmiştir. Yüzdoksanbir hastada univentriküler 32.5 ve 396 hastada biventriküler 67.5 tamir planlanmış, 141 hastada median sternotomi 24, 446 hastada torakotomi 76 uygulanmıştır. Erken dönem mortalite oranı 11.6dır. Şant yetmezliği açısından; yaş, tanı, ekstrakorporeal dolaşım ECC kullanım ihtiyacı, cerrahi yaklaşım, şant çapı anlamlı bulunmuş ve çoklu değişken lojistik regresyon analizi sonucunda cerrahi yaklaşım bağımsız risk faktörü olarak saptanmıştır p0.002. Mortalite açısından anlamlı bulunan yaş, şant çapı ve cerrahi yaklaşım arasında lojistik regresyon analizi ile sternotomi p0.0001 ve 1 ay-1 yas arası grup p0,008 bağımsız risk faktörü olarak izlenmiştir. Sonuç: Halen özellikle kompleks konjenital kalp hastalıklarında palyatif cerrahinin altenatif yaklaşımlarının azlığı sebebi ile kalp cerrahisindeki yerini koruyacağı görülmektedir. Günümüzde MBTS prosedürü için cerrahi yaklaşımlar ve yoğun bakım takip protokollerinde geniş bir bilgi birikimi ve deneyim edinilmiş olsa bile, bu hasta grubunda mortalite ve morbiditeye etkili risk faktörlerini uzun dönem sonuçları ile araştıran prospektif çalışmalara ihtiyaç vardır.

Makale detayları

Systemic to Pulmonary Shunt Techniques in Cyanotic Congenital Heart Disease Patients: An Analysis of 24 Years of Clinical Experience

Yazarlar:

Burcu Bıçakhan | Aybala Tongut | İlhan Özgöl | Alican Hatemi

Yayıncı:

Dokuz Eylul University

Ana Başlıklar:

Cerrahi

Dergi:

Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi Vol.37 Issue 2, pp.173-189

Belge Tipi:

Makale

Yayın Tarihi:

6/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001298039

pISSN:

2602-3148

Congenital heart disease

Cyanotic

Palliative procedure

ShuntKonjenital kalp hastalığı

Siyanotik

Palyatif işlem

Şant

Sayı

Makale detayları

Yazarlar: Burcu Bıçakhan | Aybala Tongut | İlhan Özgöl | Alican Hatemi

Yayıncı: Dokuz Eylul University

Ana Başlıklar: Cerrahi

Dergi: Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi Vol.37 Issue 2, pp.173-189

Belge Tipi: Makale

Yayın Tarihi: 6/2023

Belge Dili: Türkçe

Document ID (Org No.): 2001298039

pISSN: 2602-3148

Sayı

Yazarlar:

Burcu Bıçakhan | Aybala Tongut | İlhan Özgöl | Alican Hatemi

Yayıncı:

Dokuz Eylul University

Ana Başlıklar:

Cerrahi

Dergi:

Dokuz Eylül Üniversitesi Tıp Fakültesi Dergisi Vol.37 Issue 2, pp.173-189

Belge Tipi:

Makale

Yayın Tarihi:

6/2023

Belge Dili:

Türkçe

Document ID (Org No.):

2001298039

pISSN:

2602-3148