A Comparison of Blalock-Taussig Shunts With and Without Closure of the Ductus Arteriosus in Neonates With Pulmonary Atresia

Zahorec, Martin; Hrubsova, Zuzana; Skrak, Peter; Poruban, Rudolf; Nosál, Matej; Kováčiková, Ľubica

doi:10.1016/j.athoracsur.2011.04.008

Cited by 28 publications

(13 citation statements)

References 14 publications

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“…This depends on the anatomy of the pulmonary artery branches and whether there is origin stenosis affecting the branch pulmonary artery which receives the ductus. This is similar to the findings of Zahorec et al in which PDA was closed in 50% of patients (7) . All our patients were heparinized before arterial clamping and just 10% have received intraoperative protamine to reverse the effect of systemic heparinisation.…”

Section: B)supporting

confidence: 92%

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Early Outcome Following Modified Blalock-Taussig Shunt in Cyanotic Congenital Heart Diseases: Determinants of Morbidity and Mortality

Abdelmoneim¹,

Faisal²,

Hassan³

et al. 2017

Suez Canal University Medical Journal

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Background: Modified Blalock-Taussig Shunt is the most commonly used palliative shunt procedure in congenital heart disorders and is associated with significant morbidity and mortality. Aim: to improve the outcome following this surgical intervention. Subjects and Methods: Data about all children undergoing Modified Blalock-Taussig Shunt in Suez Canal University Hospitals and Cairo University Specialized Children Hospital in the time interval between March 2014 and February 2015 has been collected in three phases; pre-intra-and post-operatively then analyzed statistically. Results: Mortality in our study was 50%. The main risk factors for mortality in our study were weight urgency pre-operative prostene infusion cardiopulmonary bypass graft size and wound infection. Regarding shunt occlusion weight shunt size and intra-operative administration of protamine were statistically significant risk factors. Conclusion: Mortality rates decreased significantly with increasing weight. Cardiopulmonary Bypass graft size and wound infection were noted to be definite risk factors for mortality. Regarding acute shunt occlusion risk factors of statistical importance were weight intra-operative protamine and graft size.

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Section: B)supporting

confidence: 92%

“…There was no statistically significant relationship between acute shunt occlusion and target pulmonary artery branch size. Our work is not confined to specific age groups in contrast to other studies (4,(6)(7)(8)(9)(10)(11)(12) . All of them have specifically studied the neonatal age group.…”

Section: E) Risk Factors For Shunt Occlusionmentioning

confidence: 94%

Early Outcome Following Modified Blalock-Taussig Shunt in Cyanotic Congenital Heart Diseases: Determinants of Morbidity and Mortality

Abdelmoneim¹,

Faisal²,

Hassan³

et al. 2017

Suez Canal University Medical Journal

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“…VIS was validated in pediatric patients undergoing cardiac surgery as a marker of inotropic support as well as an established predictor of outcome (9,23). However, until now, there have been no studies using this updated vasoactive inotrope score in the adult population.…”

Section: Discussionmentioning

confidence: 99%

Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: A substudy of a randomized clinical trial

Nguyen

Havalad

Aponte-Patel

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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Objective Vasoactive medications improve hemodynamics after cardiac surgery but are associated with high metabolic and arrhythmic burdens. The vasoactive-inotropic score was developed to quantify vasoactive and inotropic support after cardiac surgery in pediatric patients but might similarly be useful in adults. Accordingly, we examined the time course of this score in a substudy of the Biventricular Pacing After Cardiac Surgery trial. We hypothesized that the score would be lower in patients randomized to biventricular pacing. Methods Fifty patients selected for increased risk of left ventricular dysfunction after cardiac surgery and randomized to temporary biventricular pacing or standard of care (no pacing) after cardiopulmonary bypass were studied in a clinical trial between April 2007 and June 2011. Vasoactive agents were assessed after cardiopulmonary bypass, after sternal closure, and 0–7 hours after admission to the intensive care unit. Results Over the initial three collection points after cardiopulmonary bypass (mean duration 131 minutes), mean vasoactive-inotropic score decreased in the biventricular pacing group from 12.0±1.5 to 10.5±2.0 and increased in the standard of care group from 12.5±1.9 to 15.5±2.9. Using a linear mixed effects model, this slopes of the time courses were statistically significant (p=0.02) and remained so for the first hour in the intensive care unit. However, the difference was no longer significant beyond this point (p=0.26). Conclusions Vasoactive-inotropic score decreases in patients undergoing temporary biventricular pacing in the early postoperative period. Future studies are needed to assess the impact of this effect on arrhythmogenesis, morbidity, mortality, and hospital costs.

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“…The technique had already been presented by Gates and colleagues (Laks method) [2] and by our group with minor modifications [3], including the data on particular patients receiving corrective secondary procedures [4].…”

Section: Aorto-goretex Central Shunt With Side-to-side Aortic Anastommentioning

confidence: 99%

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Zahorec

Nosál

Kováčiková

2012

The Annals of Thoracic Surgery

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ReplyTo The intention of our study was to present our experience from a viewpoint which is lacking in the current literature. Undoubtedly, there are both potential risks and advantages from surgical ductal non-closure during MBTS in the setting of pulmonary atresia. In response to the points made in Dr El-Rassi's letter, it is important to mention that, despite the same MBTS size and insertion site policy for all patients, no single acute deterioration from low cardiac output developed in the subgroup with the PDA left open. Hence, it is unlikely that the consequences of high pulmonary blood flow have triggered the acute hemodynamic compromise exclusively in neonates with surgically closed PDA.Petrucci and colleagues [3] reported a large cohort of 1,273 newborns with MBTS and they observed no difference in discharge mortality and morbidity according to operative PDA management. However, some relevant periprocedural data was lacking in this valuable analysis: absence or presence of additional pulmonary blood flow, surgical approach, preoperative PDA patency, preoperative prostaglandin infusion, and shunt size. Significant differences between institutions could be expected in some of the above-mentioned factors. It is noteworthy that the PDA management strategy was equally distributed between closure and nonclosure in this study. This likely reflects the individual decisionmaking for specific neonates, but one could also hypothesize that different protocols among individual centers and surgeons were used because of the absence of relevant published data.There is a need for more data about different aspects of neonatal shunt procedures (sternotomy versus thoracotomy, optimal weight adjusted shunt size, operative PDA management in different anatomic settings, and surgical approach versus PDA stenting) in the near future. Then we may be able to move from hypotheses to evidence-based strategy. In our cohort, the patient selection was mainly based on pulmonary artery diameter, ie Յ2 to 3 mm. In our modification, the main pulmonary artery was detached from the right ventricular outflow and simple clamped, and an end-to-end anastomosis of a 3-mm to 3.5-mm GoreTex graft was made to the main pulmonary artery. Holes were created at the corresponding surfaces of the graft and the lateral aortic wall, and a side-to-side anastomosis of the graft was made here, followed by oversewing of the open end of the graft. Pulmonary artery branches were not snared, and in none of our patients was cardiopulmonary bypass needed [3,4].An end-to-end anastomosis between the graft and the pulmonary artery is anatomic and provides more physiologic flow. The graft is secured from mediastinal drain compression with the anastomosis of the graft to the lateral surface of the aorta. Additionally, secondary median sternotomy and aortic cannulation are facilitated during corrective surgical procedures. In none of our cases were we faced with graft thrombosis with the 1400 CORRESPONDENCE Ann Thorac Surg 2012;93:1398 -401 MISCELLANEOUS

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A Comparison of Blalock-Taussig Shunts With and Without Closure of the Ductus Arteriosus in Neonates With Pulmonary Atresia

Cited by 28 publications

References 14 publications

Early Outcome Following Modified Blalock-Taussig Shunt in Cyanotic Congenital Heart Diseases: Determinants of Morbidity and Mortality

Early Outcome Following Modified Blalock-Taussig Shunt in Cyanotic Congenital Heart Diseases: Determinants of Morbidity and Mortality

Temporary biventricular pacing decreases the vasoactive-inotropic score after cardiac surgery: A substudy of a randomized clinical trial

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