Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease

Does aspirin make a difference?

Jennifer S. Li, Eric Yow, Katherine Y. Berezny, John F. Rhodes, Paula M. Bokesch, John R. Charpie, Geoffrey A. Forbus, Lynn Mahony, Lynn Boshkov, Virginie Lambert, Damien Bonnet, Ina Michel-Behnke, Thomas P. Graham, Masato Takahashi, James Jaggers, Robert M. Califf, Amit Rakhit, Sylvie Fontecave, Stephen P. Sanders

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)293-297
Number of pages5
JournalCirculation
Volume116
Issue number3
DOIs
StatePublished - Jul 2007

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Palliative Care
Pulmonary Artery
Aspirin
Heart Diseases
Thrombosis
Norwood Procedures
Heterotaxy Syndrome
Tricuspid Atresia
Hypoplastic Left Heart Syndrome
Pulmonary Atresia
Tetralogy of Fallot
Mortality
Infant Mortality
Cardiopulmonary Bypass
Proportional Hazards Models
Multicenter Studies
Observational Studies
Hospitalization
Morbidity

Keywords

  • Aspirin
  • Heart defects, congenital
  • Mortality
  • Shunts
  • Thrombosis

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease : Does aspirin make a difference? / Li, Jennifer S.; Yow, Eric; Berezny, Katherine Y.; Rhodes, John F.; Bokesch, Paula M.; Charpie, John R.; Forbus, Geoffrey A.; Mahony, Lynn; Boshkov, Lynn; Lambert, Virginie; Bonnet, Damien; Michel-Behnke, Ina; Graham, Thomas P.; Takahashi, Masato; Jaggers, James; Califf, Robert M.; Rakhit, Amit; Fontecave, Sylvie; Sanders, Stephen P.

In: Circulation, Vol. 116, No. 3, 07.2007, p. 293-297.

Research output: Contribution to journalArticle

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 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, vol. 116, no. 3, pp. 293-297. https://doi.org/10.1161/CIRCULATIONAHA.106.652172
Li, Jennifer S. ; Yow, Eric ; Berezny, Katherine Y. ; Rhodes, John F. ; Bokesch, Paula M. ; Charpie, John R. ; Forbus, Geoffrey A. ; Mahony, Lynn ; Boshkov, Lynn ; Lambert, Virginie ; Bonnet, Damien ; Michel-Behnke, Ina ; Graham, Thomas P. ; Takahashi, Masato ; Jaggers, James ; Califf, Robert M. ; Rakhit, Amit ; Fontecave, Sylvie ; Sanders, Stephen P. / Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease : Does aspirin make a difference?. In: Circulation. 2007 ; Vol. 116, No. 3. pp. 293-297.
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abstract = "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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T1 - Clinical outcomes of palliative surgery including a systemic-to-pulmonary artery shunt in infants with cyanotic congenital heart disease

T2 - Does aspirin make a difference?

AU - Li, Jennifer S.

AU - Yow, Eric

AU - Berezny, Katherine Y.

AU - Rhodes, John F.

AU - Bokesch, Paula M.

AU - Charpie, John R.

AU - Forbus, Geoffrey A.

AU - Mahony, Lynn

AU - Boshkov, Lynn

AU - Lambert, Virginie

AU - Bonnet, Damien

AU - Michel-Behnke, Ina

AU - Graham, Thomas P.

AU - Takahashi, Masato

AU - Jaggers, James

AU - Califf, Robert M.

AU - Rakhit, Amit

AU - Fontecave, Sylvie

AU - Sanders, Stephen P.

PY - 2007/7

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N2 - 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.

AB - 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.

KW - Aspirin

KW - Heart defects, congenital

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