gms | German Medical Science

Objective: Previous studies have established risk factors for ventriculoperitoneal shunt failure in children. However, the role of valve type as a determinant of complications and outcome remains unclear. The aim of this study was to compare the fixed-pressure paediGAV and the programmable Codman Hakim valves in the clinical setting.

Method: We conducted a retrospective review of patients younger than 16 years who underwent primary implantation of a ventriculoperitoneal shunt with either valve type at our institution between January 2005 and December 2010. Shunt survival analyses were performed to identify variables associated with risk of shunt failure.

Results: In a population of 102 patients, 44 received a paediGAV and 29 a Codman Hakim valve. In the paediGAV cohort, 50% reached the endpoint of shunt failure with a mean time of 7 months. In the Codman Hakim cohort 55% experienced shunt failure with a mean time of 8 months. There were no significant differences between both cohorts regarding reason for shunt failure, i.e. mechanical (64% vs. 59%), infectious (27% vs. 24%) or functional (9% vs. 12%). The latter category comprised 2 cases of symptomatic overdrainage requiring surgery in each cohort. To account for imbalances between cohorts, stratified analyses were performed, which identified posthemorrhagic hydrocephalus as a risk factor for shunt failure (n=0.0017). Young age at implantation showed a trend towards higher rate of subsequent failure.

Conclusions: This study confirmed some important risk factors for shunt failure in children. Despite certain limitations and biases, similar findings for both valves examined in the clinical setting were obtained. Overdrainage occurred at similar rates in both cohorts. Thus, valve type does not seem to influence risk of shunt failure. Prospective, randomized and controlled trials are required to validate these results.