Objectives The optimal arteriotomy technique for systemic‐to‐pulmonary shunts (SPS) remains uncertain. We compared the conventional slit (SL) technique with a punch‐out (PO) technique to evaluate differences in early clinical outcomes and hemodynamic characteristics. Methods This single‐center retrospective study included 49 consecutive patients who underwent SPS between 2002 and 2022. Patients were grouped according to anastomotic technique: SL, n = 38 or PO, n = 11. The primary outcome was a composite endpoint of early adverse events, including 30‐day mortality, in‐hospital mortality, acute shunt thrombosis, cardiac arrest, or need for extracorporeal membrane oxygenation. Overall survival was assessed exploratorily using Kaplan–Meier analysis. Hemodynamic characteristics were evaluated using patient‐specific computational fluid dynamics (CFD) models. Results Early shunt thrombosis occurred only in the SL group (4/38, 10.5%) and in none of the PO group patients. The predefined composite endpoint did not differ significantly between groups. Overcirculation requiring shunt clipping occurred more frequently in the PO group (45% vs. 0%, p < 0.001). Exploratory survival analysis demonstrated no significant difference in overall survival, although a sensitivity analysis restricted to 14 months showed a difference in estimated survival that should be interpreted cautiously. CFD analysis demonstrated smoother flow patterns, lower pressure loss, and reduced wall shear stress in the PO model. Conclusions The PO technique improves anastomotic flow dynamics and may reduce the risk of early shunt thrombosis; however, it may increase the risk of overcirculation. Larger prospective studies are required to confirm these findings.
Yamazaki et al. (Thu,) studied this question.