Shawndip Sen1, Jennifer Duchon1, Brooke Lampl2, Gudrun Aspelund3, Emile Bacha3, Ganga Krishnamurthy4. 1. Department of Pediatrics, Columbia University Medical Center, New York, New York. 2. Department of Radiology, Columbia University Medical Center, New York, New York. 3. Department of Surgery, Columbia University Medical Center, New York, New York. 4. Department of Pediatrics, Columbia University Medical Center, New York, New York. Electronic address: gk2008@columbia.edu.
Abstract
BACKGROUND: Cardiac-specific risks and complications after a Ladd procedure in patients with heterotaxy syndrome (HS) and intestinal rotational anomalies (IRA) are unknown. We sought to (1) describe rates of hospital mortality and early systemic-to-pulmonary (S-P) artery shunt failure after the Ladd procedure in patients with HS and (2) explore risk factors associated with early shunt failure in patients with HS with single ventricle (SV). METHODS: This retrospective study included all Ladd procedures performed from January 1999 to December 2012 in patients with HS at a single center. Risk factors investigated for early S-P artery shunt failure included birth weight, gestational age, sex, age at and timing of Ladd procedure relative to cardiac operations, and shunt type. RESULTS: Ladd procedure was performed on 54 infants with HS and congenital heart disease. Hospital mortality for the entire cohort was 5.6% (3 of 54 patients). Early shunt failure occurred in 19% (4 of 21) of HS infants with SV. Mean preoperative blood urea nitrogen (BUN) levels were higher in HS infants with early shunt failure (20 versus 12.5 mg/dL; p = 0.054). CONCLUSIONS: Patients with SV and HS with S-P artery shunts are at risk for early shunt failure after a Ladd procedure. A higher mean preoperative BUN level is noted in patients with HS and early shunt failure. Careful risk-benefit analysis is indicated before recommending routine elective Ladd procedures in patients with HS.
BACKGROUND: Cardiac-specific risks and complications after a Ladd procedure in patients with heterotaxy syndrome (HS) and intestinal rotational anomalies (IRA) are unknown. We sought to (1) describe rates of hospital mortality and early systemic-to-pulmonary (S-P) artery shunt failure after the Ladd procedure in patients with HS and (2) explore risk factors associated with early shunt failure in patients with HS with single ventricle (SV). METHODS: This retrospective study included all Ladd procedures performed from January 1999 to December 2012 in patients with HS at a single center. Risk factors investigated for early S-P artery shunt failure included birth weight, gestational age, sex, age at and timing of Ladd procedure relative to cardiac operations, and shunt type. RESULTS: Ladd procedure was performed on 54 infants with HS and congenital heart disease. Hospital mortality for the entire cohort was 5.6% (3 of 54 patients). Early shunt failure occurred in 19% (4 of 21) of HSinfants with SV. Mean preoperative blood ureanitrogen (BUN) levels were higher in HSinfants with early shunt failure (20 versus 12.5 mg/dL; p = 0.054). CONCLUSIONS:Patients with SV and HS with S-P artery shunts are at risk for early shunt failure after a Ladd procedure. A higher mean preoperative BUN level is noted in patients with HS and early shunt failure. Careful risk-benefit analysis is indicated before recommending routine elective Ladd procedures in patients with HS.
Authors: Paul Monagle; Chris Barnes; Vera Ignjatovic; Janine Furmedge; Fiona Newall; Anthony Chan; Lidia De Rosa; Simone Hamilton; Philip Ragg; Stephen Robinson; Alex Auldist; Cathy Crock; Neil Roy; Shelley Rowlands Journal: Thromb Haemost Date: 2006-02 Impact factor: 5.249
Authors: Brett R Anderson; Victoria L Blancha; Jennifer M Duchon; Paul J Chai; David Kalfa; Emile A Bacha; Ganga Krishnamurthy; Veniamin Ratner Journal: J Thorac Cardiovasc Surg Date: 2016-11-14 Impact factor: 5.209