Results of Palliation With an Initial Modified Blalock-Taussig Shunt in Neonates With Single Ventricle Anomalies Associated With Restrictive Pulmonary Blood Flow

Results of Primary Repair Versus Shunt Palliation in Ductal Dependent Infants With Pulmonary Atresia and Ventricular Septal Defect

“…During this study period, 174 neonates underwent BTS for biventricular anomalies at our institution and the mortality in those patients was 5 of 174 (2.9%) as compared with 14.9% in contemporaneous neonates who underwent BTS for single ventricle anomalies. Those results are comparable with other reports in the literature [5][6][7][8]. Interestingly, 4 of 5 of those mortalities in patients with biventricular anomalies were in patients with PAVSD.…”

“…While the higher incidence of shunt occlusion in those patients is noticeable, a practice of leaving the ductus arteriosus without ligation in those patients would likely be counterproductive by increasing diastolic runoff and consequent steal from the coronary and systemic circulation with subsequent increased mortality, in addition to the competition of flow and the possibility of increasing the risk of shunt occlusion [6]. The morbidity and mortality risk after BTS is higher in low weight patients, usually due to small grafts used and subsequent risk of occlusion, in addition to the higher incidence of steal due to the relatively large sized shunt [5,6,8,9,11]. The incidence of prematurity and low weight at time of surgery in our patients with PAVSD was high (30%) and that likely contributed to the higher mortality risk in our current series.…”

“…Disadvantages of primary repair include the use of cardiopulmonary bypass in the neonatal period, diastolic dysfunction of the noncompliant right ventricle that is often worsened in the presence of small pulmonary arteries or pulmonary regurgitation, and finally the common need to use a small sized RV-PA conduit with the need for early reoperation for conduit change [2][3][4]. On the other hand, disadvantages of BTS include the hospital and interstage mortality due to shunt-related complications such as occlusion or systemic steal, in addition to the risk of distortion of the small pulmonary arteries and the obvious need for the second stage reoperation for complete repair [4][5][6][7][8].…”

“…Hospital death and interstage mortality are well-known complications after BTS [4][5][6][7][8][9]. While outcomes of BTS in patients with cardiac anomalies amenable to biventricular repair are better than those in patients with single ventricle anomalies, the mortality risk in patients with biventricular anomalies is not negligible [5][6][7][8][9]. During this study period, 174 neonates underwent BTS for biventricular anomalies at our institution and the mortality in those patients was 5 of 174 (2.9%) as compared with 14.9% in contemporaneous neonates who underwent BTS for single ventricle anomalies.…”

“…The 2 surgical treatment strategies that are applied in ductal-dependent PAVSD patients include either a single stage strategy of primary neonatal biventricular repair (BVR) or a staged strategy of initial palliation with a modified Blalock-Taussig shunt (BTS) followed by a second stage repair. Each of those two strategies is associated with specific advantages and drawbacks [2][3][4][5][6][7][8]. We aim in the current series to report current era results of surgical treatment of neonates born with ductal-dependent PAVSD at our institution; to examine risk factors affecting early and late outcomes and to compare early mortality, late survival, and right ventricular outflow tract (RVOT) reoperation risk between the 2 management strategies.…”