Modified Blalock Taussig shunt: a not-so-simple palliative procedure

Abstract

OBJECTIVES: Thirty-two consecutive isolated modified Blalock Taussig (BT) shunts performed in infancy since 2004 were reviewed and analysed to identify the risk factors for shunt intervention and mortality. METHODS:Sternotomy was the only approach used. Median age and weight were 10.5 (range 1-74) days and 2.9 (1.9-4.4) kg, respectively. Shunt palliation was performed for biventricular hearts (Tetralogy of Fallot/double outlet right ventricle/transposition of great arteries_ventricular septal defect_pulmonary stenosis/pulmonary atresia_ventricular septal defect/others) in 21, and univentricular hearts in 11, patients. Hypoplastic left heart syndrome patients were excluded. Two procedures required cardiopulmonary bypass. Median shunt size was 3.5 (3-4) mm and median shunt size/kg body weight was 1.2 (0.9-1.7) mm/kg. Reduction in shunt size was necessary in 5 of 32 (16%) patients. RESULTS:Three of 32 (9%) patients died after 3 (1-15) days due to cardiorespiratory decompensation. Lower body weight (P = 0.04) and bigger shunt size/kg of body weight (P = 0.004) were significant risk factors for mortality. Acute shunt thrombosis was observed in 3 of 32 (9%), none leading to death. Need for cardiac decongestive therapy was associated with univentricular hearts (P < 0.001), bigger shunt size (P = 0.054) and longer hospital stay (P = 0.005). Twenty-eight patients have undergone a successful shunt takedown at a median age of 5.5 (0.5-11.9) months, without late mortality.CONCLUSIONS: Palliation with a modified BT shunt continues to be indicated despite increased thrust on primary corrective surgery. Though seemingly simple, it is associated with significant morbidity and mortality. Effective over-shunting and acute shunt thrombosis are the lingering problems of shunt therapy.

Modified Blalock Taussig shunt: Comparison between neonates, infants and older children

“…One study, indeed, classified adrenaline ± noradrenaline ± milrinone as normal inotropic support. [15] The most common complication in our study was postoperative bleeding. None of the patients developed any seroma, phrenic nerve palsy or sepsis.…”

“…These values are higher as compared to other studies [13][14][15]18,19] We selected all the children undergoing MBTS surgery in a 2 year period, whereas other investigators defined age limits for their research and have concentrated on neonates. [10,13,14,19,20] Although, palliation with definite procedures is becoming common in young age, many older children still undergo MBTS because of complex anatomy, underdeveloped branch PAs and/or systemic desaturation (emergency MBTS).…”

“…The overall mortality and infant mortality of 4.5% and 8%, respectively is comparable with other studies. [7,15,17,21] No child older than 1 year died. This significant difference in mortality could be due to larger vessels, less vulnerable physiology and technically less demanding surgery in older children.…”

“…[5] Other anomalies Shauq et al [8] in their study have reported significantly longer ventilation time, inotropic support requirement, and Intensive Care Unit (ICU) and hospital stay in children undergoing MBTS through a sternotomy. In spite of wide clinical experience, the overall mortality with MBTS varies between 2.3% and 16% [9][10][11][12] and around 9-11% [13][14][15] for neonatal Blalock Taussig (BT) shunts. This retrospective analysis was designed with the following objectives: 1.…”

Stenting of the ductus arteriosus in infants with functionally univentricular heart disease and ductal‐dependent pulmonary blood flow: A single‐center experience

“…The surgical SP shunt operation still stands out as a preferable option in the palliation of patients with restricted pulmonary blood flow when total correction is not possible . DS has been reported as a reasonable, less invasive alternative to the conventional SP shunt procedure for patients with ductal‐dependent pulmonary circulation.…”