Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis.
<h4>Objective</h4>To determine risk factors affecting time-to-death ≤90 and >90 days in children who underwent a modified Blalock-Taussig shunt (MBTS).<h4>Methods</h4>Data from a retrospective cohort study were obtained from children aged 0-3 years who experienced MBTS bet...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0245754 |
| _version_ | 1818919851662508032 |
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| author | Maliwan Oofuvong Jutarat Tanasansuttiporn Wirat Wasinwong Voravit Chittithavorn Pongsanae Duangpakdee Jirayut Jarutach Qistina Yunuswangsa |
| author_facet | Maliwan Oofuvong Jutarat Tanasansuttiporn Wirat Wasinwong Voravit Chittithavorn Pongsanae Duangpakdee Jirayut Jarutach Qistina Yunuswangsa |
| author_sort | Maliwan Oofuvong |
| collection | DOAJ |
| description | <h4>Objective</h4>To determine risk factors affecting time-to-death ≤90 and >90 days in children who underwent a modified Blalock-Taussig shunt (MBTS).<h4>Methods</h4>Data from a retrospective cohort study were obtained from children aged 0-3 years who experienced MBTS between 2005 and 2016. Time-to-death (prior to Glenn/repair), time-to-alive up until December 2017 without repair, and time-to-progression to Glenn/repair following MBTS were presented using competing risks survival analysis. Demographic, surgical and anesthesia-related factors were recorded. Time-to-death ≤90 days and >90 days was analyzed using multivariate time-dependent Cox regression models to identify independent predictors and presented by adjusted hazard ratios (HR) and 95% confidence intervals (CI).<h4>Results</h4>Of 380 children, 119 died, 122 survived and 139 progressed to Glenn/repair. Time-to-death probability (95% CI) within 90 days was 0.18 (0.14-0.22). Predictors of time-to-death ≤90 days (n = 63) were low weight (<3 kg) (HR 7.6, 95% CI:2.8-20.4), preoperative ventilator support (HR 2.7, 95% CI:1.3-5.6), postoperative shunt thrombosis (HR 5.0, 95% CI:2.4-10.4), bleeding (HR 4.5, 95% CI:2.1-9.4) and renal failure (HR 4.1, 95% CI:1.5-10.9). Predictors of time-to-death >90 days (n = 56) were children diagnosed with pulmonary atresia with ventricular septal defect and single ventricle (compared to tetralogy of fallot) (HR 3.2, 95% CI:1.2-7.7 and HR 3.1, 95% CI:1.3-7.6, respectively), shunt size/weight ratio >1.1 vs <0.65 (HR 6.8, 95% CI:1.4-32.6) and longer duration of mechanical ventilator (HR 1.002, 95% CI:1.001-1.004). Shunt size/weight ratio ≥1.0 (vs <1.0) and ≥0.65 (vs <0.65) were predictors for overall time-to-death in neonates and toddlers, respectively (HR 13.1, 95% CI:2.8-61.4 and HR 7.8, 95% CI:1.7-34.8, respectively).<h4>Conclusions</h4>Perioperative factors were associated with time-to-death ≤90 days, whereas particular cardiac defect, larger shunt size/weight ratio, and longer mechanical ventilation were associated with time-to-death >90 days after receiving MBTS. Larger shunt size/weight ratio should be reevaluated within 90 days to minimize the risk of shunt over flow. |
| first_indexed | 2024-12-20T01:12:26Z |
| format | Article |
| id | doaj.art-280dc31ccbe6463c9d36777c5c1b48aa |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-20T01:12:26Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-280dc31ccbe6463c9d36777c5c1b48aa2022-12-21T19:58:39ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01161e024575410.1371/journal.pone.0245754Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis.Maliwan OofuvongJutarat TanasansuttipornWirat WasinwongVoravit ChittithavornPongsanae DuangpakdeeJirayut JarutachQistina Yunuswangsa<h4>Objective</h4>To determine risk factors affecting time-to-death ≤90 and >90 days in children who underwent a modified Blalock-Taussig shunt (MBTS).<h4>Methods</h4>Data from a retrospective cohort study were obtained from children aged 0-3 years who experienced MBTS between 2005 and 2016. Time-to-death (prior to Glenn/repair), time-to-alive up until December 2017 without repair, and time-to-progression to Glenn/repair following MBTS were presented using competing risks survival analysis. Demographic, surgical and anesthesia-related factors were recorded. Time-to-death ≤90 days and >90 days was analyzed using multivariate time-dependent Cox regression models to identify independent predictors and presented by adjusted hazard ratios (HR) and 95% confidence intervals (CI).<h4>Results</h4>Of 380 children, 119 died, 122 survived and 139 progressed to Glenn/repair. Time-to-death probability (95% CI) within 90 days was 0.18 (0.14-0.22). Predictors of time-to-death ≤90 days (n = 63) were low weight (<3 kg) (HR 7.6, 95% CI:2.8-20.4), preoperative ventilator support (HR 2.7, 95% CI:1.3-5.6), postoperative shunt thrombosis (HR 5.0, 95% CI:2.4-10.4), bleeding (HR 4.5, 95% CI:2.1-9.4) and renal failure (HR 4.1, 95% CI:1.5-10.9). Predictors of time-to-death >90 days (n = 56) were children diagnosed with pulmonary atresia with ventricular septal defect and single ventricle (compared to tetralogy of fallot) (HR 3.2, 95% CI:1.2-7.7 and HR 3.1, 95% CI:1.3-7.6, respectively), shunt size/weight ratio >1.1 vs <0.65 (HR 6.8, 95% CI:1.4-32.6) and longer duration of mechanical ventilator (HR 1.002, 95% CI:1.001-1.004). Shunt size/weight ratio ≥1.0 (vs <1.0) and ≥0.65 (vs <0.65) were predictors for overall time-to-death in neonates and toddlers, respectively (HR 13.1, 95% CI:2.8-61.4 and HR 7.8, 95% CI:1.7-34.8, respectively).<h4>Conclusions</h4>Perioperative factors were associated with time-to-death ≤90 days, whereas particular cardiac defect, larger shunt size/weight ratio, and longer mechanical ventilation were associated with time-to-death >90 days after receiving MBTS. Larger shunt size/weight ratio should be reevaluated within 90 days to minimize the risk of shunt over flow.https://doi.org/10.1371/journal.pone.0245754 |
| spellingShingle | Maliwan Oofuvong Jutarat Tanasansuttiporn Wirat Wasinwong Voravit Chittithavorn Pongsanae Duangpakdee Jirayut Jarutach Qistina Yunuswangsa Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis. PLoS ONE |
| title | Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis. |
| title_full | Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis. |
| title_fullStr | Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis. |
| title_full_unstemmed | Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis. |
| title_short | Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis. |
| title_sort | predictors of death after receiving a modified blalock taussig shunt in cyanotic heart children a competing risk analysis |
| url | https://doi.org/10.1371/journal.pone.0245754 |
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