Evaluation of 60 cases of systemic-pulmonary shunt with cardiopulmonary bypass.

OBJECTIVE: In recent years, the median sternotomy approach with cardiopulmonary bypass has been increasingly chosen when systemic-pulmonary shunt surgery is performed as initial palliation for congenital heart diseases with decreased pulmonary blood flow to secure a stable surgical field and to maintain a stable circulation and oxygen supply. Since 2007, this strategy has been applied in our institute. This time, we examine the advantage and disadvantage of this procedure by evaluating the intraoperative and postoperative courses.

METHODS: The study investigated 60 cases that underwent systemic-pulmonary shunt surgery under cardiopulmonary bypass at our facility after August 2007. Original diagnosis, age and body weight at surgery, shunt procedure, concomitant procedure, and surgical times were evaluated. The postoperative course of each case and the results of subsequent surgeries were also examined.

RESULTS: No death or severe complication occurred during surgery or in the perioperative period. The age at surgery was 4 days-12 years (median 5.1 months), and the body weight was 2.3-28.1 (median 4.7) kg. Surgical procedures were as follows: right modified Blalock-Taussig shunt (mBTS): 35, left mBTS: 11, and central shunt: 14. In addition, the following simultaneous surgeries were conducted: pulmonary artery plasty: 11, unifocalization: 5, main pulmonary artery ligation: 2, interatrial communication enlargement: 4, and total anomalous pulmonary venous drainage repair: 2.

CONCLUSION: The outcomes at our facility have validated the safety of systemic-pulmonary shunt surgeries under cardiopulmonary bypass, and even the disadvantages of concern were believed to be within acceptable limits. Further innovation and examination are important in pursuit of even less invasive surgeries.