Which children with CHD are at highest risk of early shunt failure?
Because in–hospital shunt failure is common among children with congenital heart disease (CHD), a CHOP researcher investigated risk factors for this potentially catastrophic complication. Nhue Do, MD, a Cardiology Fellow at Children’s Hospital of Philadelphia analyzed data from a large multicenter clinical registry, the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS–CHSD).

Dr. Do and colleagues investigated records for over 9,100 infants from 118 centers who underwent shunt operations (systemic artery–to–pulmonary artery or systemic ventricle–to–pulmonary artery) from 2010 to 2015, presenting results recently at the Society for Thoracic Surgeons meeting in Phoenix.

In–hospital shunt failure occurred in 674 (7.3 percent) of the 9,172 infants, all younger than 1 year old. Risk factors for in–hospital shunt failure included lower weight at operation, preoperative hypercoagulable state, and the presence of any other STS–CHSD preoperative risk factors. Patients with in–hospital shunt failure had significantly higher rates of operative mortality, greater morbidity, and longer median post–operative length of stay among survivors. Shunt failure was less likely with systemic ventricle–to–pulmonary artery shunt than with systemic artery–to–pulmonary artery shunt. Neither cardiopulmonary bypass nor single ventricle diagnosis were risk factors for shunt failure.

“These data highlight at–risk patients and procedural cohorts that warrant expectant surveillance,” says Dr. Do. “Further studies are needed to characterize this subset of patients that may benefit from enhanced anti–thrombotic prophylaxis or other management strategies to reduce shunt failure.”