Pulmonary systemic fistula for palliative management of congenital heart disease: A decade of observations

Abstract

BackgroundSystemic-pulmonary fistula remains a critical palliative procedure for congenital heart diseases in pediatric patients but is associated with considerable morbidity and mortality. MethodsThis retrospective cohort study reviewed records of 485 patients undergoing this surgery at a leading tertiary care center from 2010 to 2020. ResultsThe median age at surgery was 6 months, predominantly for conditions like tetralogy of Fallot and pulmonary atresia. Preoperative factors like hemodynamic instability, pre-surgical intubation, and cardiovascular drug use were significant (OR 1.76, 1.65, 1.51 respectively). Thoracotomy was the most common approach (58%), linked to fewer complications (OR 0.37). Complications occurred in 13% of cases, including postoperative bleeding (4.6%) and fistula obstruction (4.3%). Additional interventions (OR 2.25) and reoperations (OR 6.88) correlated with higher complication rates and mortality (9.2%), notably in newborns. Sternotomy had the highest mortality incidence. ConclusionManaging preoperative risks like hemodynamic instability is crucial for improving outcomes, especially in children under 2 years old. This study underscores the challenges in systemic-pulmonary fistula management and emphasizes the impact of surgical approach on complication rates, advocating for tailored strategies to optimize outcomes in this vulnerable patient population.