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Objective The objective was to analyze the risk factors for the early death in patients after systemic-pulmonary shunt in order to improve the operative results.Methods Between February 2002 and June 2012, 201 patients with age from 3 months to13 years (3.5±3.2 years), and weight from 3.5 to 36 Kg (13.3±10.0 Kg) , underwent a systemic-pulmonary shunt.The surgical procedure included central aortopulmonary shunt (Waterston) in 105 patients, modified Blalock-Taussig shunt in 64 patients and Melbourne shunt in 32 patients.We reviewed the clinic data and analyze the risk factors for operative outcomes.Results The early mortality was 7.0%.Univariate analysis revealed youngage, low body weight, pulmonary/intact ventricle,preoperative low hemoglobin, patency duct arteries, severe intra-operative hypotention or arrhythmia, acute shunt blockage within the first 24 h and postoperative acute pulmonary edema as risk factors for early death.In the multivariate analysis, acute shunt blockage and postoperative acute pulmonary edema were independent risk factors of early death.Conclusions Early outcomes after systemic-pulmonary shunt can be improved by preventing acute shunt blockage andchoose suitable shunt size to decrease the morbidity of acute pulmonary edema, especially in the patients with youngage and low body weight.