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

Dirks, Verena ; Prêtre, René ; Knirsch, Walter ; Valsangiacomo Buechel, Emanuela R. ; Seifert, Burkhardt ; Schweiger, Martin ; Hübler, Michael ; Dave, Hitendu

In: European Journal of Cardio-Thoracic Surgery, 2013, vol. 44, no. 6, p. 1096-1102

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    Titre
    • Modified Blalock Taussig shunt: a not-so-simple palliative procedure
    Auteur
    • Dirks, Verena. Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
    • Prêtre, René. Department of Cardiovascular Surgery, University Hospital Lausanne, Lausanne, Switzerland
    • Knirsch, Walter. Department of Paediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
    • Valsangiacomo Buechel, Emanuela R.. Department of Paediatric Cardiology, University Children's Hospital Zurich, Zurich, Switzerland
    • Seifert, Burkhardt. Division of Biostatistics, Institute for Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
    • Schweiger, Martin. Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
    • Hübler, Michael. Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
    • Dave, Hitendu. Division of Congenital Cardiovascular Surgery, University Children's Hospital Zurich, Zurich, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Cardio-Thoracic Surgery, 2013, vol. 44, no. 6, p. 1096-1102. Oxford University Press
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:295611
    Summary
    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