Back to Search
Start Over
Pulmonary-to-Systemic Arterial Shunt to Treat Children With Severe Pulmonary Hypertension.
- Source :
-
Journal of the American College of Cardiology (JACC) . Aug2021, Vol. 78 Issue 5, p468-477. 10p. - Publication Year :
- 2021
-
Abstract
- <bold>Background: </bold>The placement of a pulmonary-to-systemic arterial shunt in children with severe pulmonary hypertension (PH) has been demonstrated, in relatively small studies, to be an effective palliation for their disease.<bold>Objectives: </bold>The aim of this study was to expand upon these earlier findings using an international registry for children with PH who have undergone a shunt procedure.<bold>Methods: </bold>Retrospective data were obtained from 110 children with PH who underwent a shunt procedure collected from 13 institutions in Europe and the United States.<bold>Results: </bold>Seventeen children died in-hospital postprocedure (15%). Of the 93 children successfully discharged home, 18 subsequently died or underwent lung transplantation (20%); the mean follow-up was 3.1 years (range: 25 days to 17 years). The overall 1- and 5-year freedom from death or transplant rates were 77% and 58%, respectively, and 92% and 68% for those discharged home, respectively. Children discharged home had significantly improved World Health Organization functional class (P < 0.001), 6-minute walk distances (P = 0.047) and lower brain natriuretic peptide levels (P < 0.001). Postprocedure, 59% of children were weaned completely from their prostacyclin infusion (P < 0.001). Preprocedural risk factors for dying in-hospital postprocedure included intensive care unit admission (hazard ratio [HR]: 3.2; P = 0.02), mechanical ventilation (HR: 8.3; P < 0.001) and extracorporeal membrane oxygenation (HR: 10.7; P < 0.001).<bold>Conclusions: </bold>A pulmonary-to-systemic arterial shunt can provide a child with severe PH significant clinical improvement that is both durable and potentially free from continuous prostacyclin infusion. Five-year survival is comparable to children undergoing lung transplantation for PH. Children with severely decompensated disease requiring aggressive intensive care are not good candidates for the shunt procedure. [ABSTRACT FROM AUTHOR]
- Subjects :
- *EXTRACORPOREAL membrane oxygenation
*INTENSIVE care units
*LUNG transplantation
*PULMONARY hypertension
*BRAIN natriuretic factor
*CRITICAL care medicine
*CARDIOVASCULAR surgery
*RESEARCH
*SURGICAL anastomosis
*RESEARCH methodology
*PULMONARY artery
*RETROSPECTIVE studies
*MEDICAL cooperation
*EVALUATION research
*SEVERITY of illness index
*COMPARATIVE studies
Subjects
Details
- Language :
- English
- ISSN :
- 07351097
- Volume :
- 78
- Issue :
- 5
- Database :
- Academic Search Index
- Journal :
- Journal of the American College of Cardiology (JACC)
- Publication Type :
- Academic Journal
- Accession number :
- 151467007
- Full Text :
- https://doi.org/10.1016/j.jacc.2021.05.039