Congenital Left-to-right Shunts with Severe Pulmonary Artery Hypertension: Comparison of Outcomes of Surgical or Non-surgical Treatment Adjusted by Propensity Score

  • Huili Gan, Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University (BAZH—CMU) 100029 Beijing China, China
  • Jian-qun Zhang, Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University (BAZH—CMU) 100029 Beijing China, China
  • Qi-wen Zhou, Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University (BAZH—CMU) 100029 Beijing China, China
  • Ping Bo, Cardiac Surgery Department, Beijing Anzhen Hospital, Capital Medical University (BAZH—CMU) 100029 Beijing China, China

    • Objective: Our aim was to investigate the relationship between the long-term survival of surgical treatment and preoperative pulmonary vascular resistance (PVR) and pulmonary to systemic flow ratio (Qp/Qs) in congenital left to right shunts with severe pulmonary hypertension (PH).
    Methods: 1212 cases of congenital left to right shunts with severe PH were treated non-surgically (n=297) or surgically (n=915). Propensity scores for inclusion into surgical group were calculated for each patient and were used to match 245 pairs between the two groups. Kaplan-Meier survival curves were constructed with PVR stratum at the level of 15 WU or with Qp/Qs stratum at the level of 1.25.
    Results: In the 245 propensity score matched pairs, the actuarial survival of the surgical group was significantly higher than that of the non-surgical group when PVR was less than 15 WU or Qp/Qs was larger than 1.25(P = 0.000 and 0.001), but the actuarial survival between the two groups had no difference when PVR was larger than 15 WU or Qp/Qs was less than 1.25 (P = 0.596 and 0.424). Cox proportional hazard analysis revealed that hemoglobin higher than 160g/L, PVR larger than 15 WU, and Qp/Qs less than 1.25 were the independent risk predictors for the late death.
    Conclusion: Surgical criteria for congenital systemic-to-pulmonary shunts with severe PH should be revised as preoperative PVR less than 15 WU and Qp/Qs larger than 1.25. For patients with PVR greater than 15 WU and/ or its Qp/Qs less than 1.25, surgical closure therapy provides no benefits.