Neointimal hyperplasia in systemic-to-pulmonary shunts of children with complex cyanotic congenital heart disease. (25th August 2022)

• Record Type: Journal Article
• Authors: Kottmann, Philip; Cleuziou, Julie; Lemmer, Julia; Eildermann, Katja; Vitanova, Keti; von-Stumm, Maria; Lehmann, Luisa; Horer, Jurgen; Ewert, Peter; Sigler, Matthias; Wolf, Cordula M
• Is Part Of: European journal of cardio-thoracic surgery. Volume 62:Number 6(2022)
• Publication Date: 2022-08-25
• Subjects: Neointimal hyperplasia -- Systemic-to-pulmonary shunt -- Shunt malfunction -- Norwood procedure -- Hypoplastic left heart syndrome -- Cyanotic heart defects; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezac431
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Neointimal hyperplasia might affect systemic-to-pulmonary shunt failure in infants with complex cyanotic congenital heart disease. The aim of this study was to elucidate histopathologic changes in polytetrafluoroethylene shunts and to determine whether increased neointimal formation is associated with early interventions comprising balloon dilatation, stent implantation and shunt revision. Furthermore, we intended to identify clinical factors associated with increased neointimal proliferation. METHODS: Removed shunts were processed for histopathological analysis. Slides were stained with hematoxylin/eosin and Richardson. Immunohistochemistry was performed with anti-alpha-smooth muscle actin and anti-CD68. Non-parametric analysis and univariable regressions were performed to identify clinical factors associated with neointimal hyperplasia and shunt stenosis. RESULTS: Fifty-seven shunts (39 modified Blalock–Taussig anastomosis, 8 right ventricle-to-pulmonary artery anastomosis, 10 central shunts) were analysed. Area of neointimal proliferation within the shunt was in median 0.75 mm 2 (interquartile range, 0.3–1.57 mm 2 ) and relative shunt stenosis in median 16.7% (interquartile range, 6.7–30.8%). Neointimal hyperplasia and shunt stenosis correlated with each other and were significantly greater in the group that required early interventions and shunt revision. Univariable linear regression identified smaller shunt size and lower acetylsalicylic acid dosage as factors to be associated with greater neointimal proliferation and shunt stenosis. CONCLUSIONS: In infants with complex cyanotic congenital heart disease, neointimal hyperplasia in systemic-to-pulmonary shunts is associated with early interventions comprising balloon dilatation, stent implantation and shunt revision. Smaller shunt size and lower aspirin dosage are associated with increased neointimal proliferation. Abstract : Systemic-to-pulmonary (SP) shunts are implanted in neonates with single-ventricle physiology at stage I of Norwood palliation and in children with other complex cyanotic congenital heart disease to ensure systemic and/or pulmonary perfusion until stage II palliation, corrective surgery or other follow-up procedures.