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Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease: does aspirin make a difference?

Publication ,  Journal Article
Li, JS; Yow, E; Berezny, KY; Rhodes, JF; Bokesch, PM; Charpie, JR; Forbus, GA; Mahony, L; Boshkov, L; Lambert, V; Bonnet, D; Michel-Behnke, I ...
Published in: Circulation
July 17, 2007

BACKGROUND: Aspirin (ASA) often is used to prevent thrombosis in infants with congenital heart disease after placement of a systemic-to-pulmonary artery shunt, but its effect on outcomes is unknown. METHODS AND RESULTS: The present multicenter study prospectively collected data on 1-year postoperative rates of death, shunt thrombosis, or hospitalization age <4 months for bidirectional Glenn/hemi-Fontan surgery in 1004 infants. The use and dose of ASA were recorded. Kaplan-Meier event rates were calculated for each event and the composite outcome, and a Cox regression model was constructed for time to event. Model terms were ASA use and type of surgery, with adjustment for age at surgery. Diagnoses were hypoplastic left heart syndrome (n=346), tricuspid atresia (n=103), tetralogy of Fallot (n=127), pulmonary atresia (n=177), heterotaxy syndrome (n=38), and other (n=213). There were 344 shunts placed without cardiopulmonary bypass (closed shunt), 287 shunts with bypass (open shunt), 323 Norwood procedures, and 50 Sano procedures. Overall, 80% of patients received ASA. One-year postoperative events rates were high: 38% for the composite end point, 26% for death, and 12% for shunt thrombosis. After the exclusion of patients with early mortality, patients receiving ASA had a lower risk of shunt thrombosis (hazard ratio, 0.13; P=0.008) and death (closed shunt: hazard ratio, 0.41, P=0.057; open shunt: hazard ratio, 0.10, P<0.001; Norwood: hazard ratio, 0.34, P<0.001; Sano: hazard ratio, 0.68, P=NS) compared with those not receiving ASA. CONCLUSIONS: The morbidity and mortality for infants after surgical placement of a systemic-to-pulmonary artery shunt are high. ASA appears to lower the risk of death and shunt thrombosis in the present observational study.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 17, 2007

Volume

116

Issue

3

Start / End Page

293 / 297

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Pulmonary Artery
  • Prospective Studies
  • Palliative Care
  • Infant
  • Humans
  • Heart Defects, Congenital
  • Cardiovascular System & Hematology
  • Cardiac Surgical Procedures
  • Aspirin
 

Citation

APA
Chicago
ICMJE
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Li, J. S., Yow, E., Berezny, K. Y., Rhodes, J. F., Bokesch, P. M., Charpie, J. R., … Sanders, S. P. (2007). Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease: does aspirin make a difference? Circulation, 116(3), 293–297. https://doi.org/10.1161/CIRCULATIONAHA.106.652172
Li, Jennifer S., Eric Yow, Katherine Y. Berezny, John F. Rhodes, Paula M. Bokesch, John R. Charpie, Geoffrey A. Forbus, et al. “Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease: does aspirin make a difference?Circulation 116, no. 3 (July 17, 2007): 293–97. https://doi.org/10.1161/CIRCULATIONAHA.106.652172.
Li, Jennifer S., et al. “Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease: does aspirin make a difference?Circulation, vol. 116, no. 3, July 2007, pp. 293–97. Pubmed, doi:10.1161/CIRCULATIONAHA.106.652172.
Li JS, Yow E, Berezny KY, Rhodes JF, Bokesch PM, Charpie JR, Forbus GA, Mahony L, Boshkov L, Lambert V, Bonnet D, Michel-Behnke I, Graham TP, Takahashi M, Jaggers J, Califf RM, Rakhit A, Fontecave S, Sanders SP. Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease: does aspirin make a difference? Circulation. 2007 Jul 17;116(3):293–297.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

July 17, 2007

Volume

116

Issue

3

Start / End Page

293 / 297

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Pulmonary Artery
  • Prospective Studies
  • Palliative Care
  • Infant
  • Humans
  • Heart Defects, Congenital
  • Cardiovascular System & Hematology
  • Cardiac Surgical Procedures
  • Aspirin