Outcomes and Risk Factors for Morbidity and Mortality of Systemic-to-Pulmonary Shunts in a Tertiary Hospital in Thailand

Abstract

Objectives: A systemic-to-pulmonary shunt is the palliation of choice for many children with cyanotic congenital heart disease. However, significant morbidity and mortality related to these procedures and the postoperative course still exists. We aim to report our outcomes of systemic-to-pulmonary shunts as well as to define certain risk factors for adverse events. Materials and Methods: We retrospectively collected data from the electronic medical records of Ramathibodi hospital from January 01, 2013, to April 30, 2024. Demographic data, operative, and postoperative details were collected and reviewed. Inclusion criteria included patients whose primary operation was a systemic-to-pulmonary shunt. Exclusion criteria were patients diagnosed with hypoplastic left heart syndrome and whose medical record data were missing significant information. Results: There were initially 56 patients eligible for our study. After exclusion, the total number of patients enrolled was 42. Overall the results were excellent, with only one operative mortality, no discharge mortality, and four reinterventions. Outcomes between different shunt types, shunt sizes, surgical approaches, and diagnoses were statistically similar. Conclusions: We demonstrate that systemic-to-pulmonary shunts are a safe and reliable procedure based on our results at a tertiary hospital in Thailand. We emphasize meticulous surgical techniques as well as utilization of proper and reproducible postoperative care protocols to optimize patient outcomes.