Major Adverse Events Following Over-Shunting Are Associated With Worse Outcomes Than Major Adverse Events After a Blocked Systemic-to-Pulmonary Artery Shunt Procedure

Objectives: Causes of major adverse event after systemic-to-pulmonary shunt procedure are usually shunt occlusion or over-shunting. Outcomes categorized on the basis of these causes will be helpful both for quality improvement and prognostication. Design: Retrospective cohort analysis of children who underwent a systemic-to-pulmonary shunt after excluding those who had it for Norwood or Damus-Kaye-Stansel procedure. Setting: The Royal Children’s Hospital, Melbourne, VIC, Australia. Patients: From 2008 to 2015, 201 children who had a systemic-to-pulmonary shunt were included. Interventions: Major adverse event is defined as one or more of cardiac arrest, chest reopening, or requirement for extracorporeal membrane oxygenation. Study outcome is a “composite poor outcome,” defined as one or more of acute kidney injury, necrotizing enterocolitis, brain injury, or in-hospital mortality. Measurements and Main Results: Median (interquartile range) age was 12 days (6–38 d) and median (interquartile range) time to major adverse event was 5.5 hours (2–17 hr) after admission. Overall, 36 (18%) experienced a major adverse event, and reasons were over-shunting (n = 17), blocked shunt (n = 13), or other (n = 6). Fifteen (88%) in over-shunting group suffered a cardiac arrest compared with two (15%) in the blocked shunt group (p

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