Surgical Approaches to the Blalock Shunt

Shauq, Arjamand; Agarwal, Vijay; Karunaratne, Ajith; Gladman, Gordon; Pozzi, Marco; Kaarne, Markku; Ladusans, E J

doi:10.1016/j.hlc.2010.02.025

Cited by 17 publications

(14 citation statements)

References 11 publications

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“…[4] Earlier, the classic BT shunt was replaced by the MBTS where a PTFE graft is placed between the SCA and branch PA. Now the most widely used technique of de Leval [16] (via posterolateral thoracotomy) is being challenged by the proponents of sternotomy. [7,8,17] Odim et al [7] reported that a MBTS was 4 times more likely to fail if performed via thoracotomy rather than sternotomy. Kandakure et al, [17] emphasized that thoracotomy approach can cause distal PA distortion and since the shunt is placed more centrally through sternotomy the growth of branch PAs is more uniform.…”

Section: Discussionmentioning

confidence: 99%

“…[4] The indications for MBTS have been extended to include congenital cyanotic heart defects presenting with hypercyanotic spells, failure to thrive and pulmonary arteries being too small for a safe corrective repair. [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.…”

Section: Introductionmentioning

confidence: 95%

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

et al. 2014

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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

et al. 2014

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“…Depending on the side of the thoracotomy, it may not be always possible to perform PDA ligation, but with a sternotomy, it is always possible. In the end, whether or not to close the duct remains a strategic decision [13].…”

Section: Sternotomy or Thoracotomymentioning

confidence: 99%

“…While the Boston group [6] reported four times higher risk of shunt failures through a thoracotomy when compared with a sternotomy, Shauq et al [13] have reported significantly longer ventilation time, inotropic support, intensive care unit (ICU) stay and hospital stay in the sternotomy group. These findings reflect the learning curve involved with shunts created through a sternotomy.…”

Section: Sternotomy or Thoracotomymentioning

confidence: 99%

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

Dirks

Prêtre²,

Knirsch

et al. 2013

European Journal of Cardio-Thoracic Surgery

111

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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.

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“…The shift from the traditional posterolateral thoracotomy towards sternotomy gained momentum as other workers [11] reported that the MBTS performed through a thoracotomy approach has 4 times the risk for shunt failure as compared to a sternotomy approach. More recent workers have not demonstrated the superiority of shunt patency reported with the sternotomy approach; rather there are indications that the median sternotomy approach for MBTS may have a higher morbidity in terms of longer ventilation times, longer duration of inotropic support, intensive care, and hospital stay [12]. Some have even suggested that the sternal approach for MBTS construction is an independent risk factor for in-hospital death [9], although it is conceivable that sternotomy is merely a surrogate for a higher risk patient or procedure.…”

Section: Discussionmentioning

confidence: 99%

Strictly-posterior thoracotomy: a minimal-access approach for construction of the modified Blalock-Taussig shunt in West African children

Edwin¹,

Gyan²,

Adzamli³

et al. 2014

Pan Afr Med J

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IntroductionIn resource-poor settings, the modified Blalock-Taussig shunt (MBTS) is often performed for symptomatic relief of Fallot's tetralogy. From September 2011, we adopted the strictly posterior thoracotomy (SPOT), a minimal-access technique for the MBTS and report the cosmetic advantages in this communication.MethodsWe retrospectively analyzed the records of consecutive patients in whom the SPOT approach was used to construct the MBTS. Study end-points were early mortality, improvement in peripheral oxygenation, morbidity, and the cosmetic appeal.ResultsBetween September 2011 and January 2013, 15 males and 8 females, median age 4 years (1.3 - 17 years) and weight 13 kg (11 - 54 kg) underwent the MBTS through the SPOT approach. The polytetrafluoroethylene grafts used ranged from sizes 4 - 6mm (median 5mm). The median preoperative SpO2 was 74% (55% - 78%), increasing to a postoperative median value of 84% (80% - 92%). Shunts were right-sided in 22 patients and left-sided in one. There were no shunt failures. Hospital stay ranged from 7 - 10 days. There was one early death (4.3%), and two postoperative complications (re-exploration for bleeding and readmission for drainage of pleural effusion). The surgical scars had excellent cosmetic appeal: they ranged from 5-10 cm in length; all were entirely posterior and imperceptible to the patient.ConclusionThe SPOT approach represents a safe and cosmetically superior alternative to the standard posterolateral thoracotomy, the scar being imperceptible to the patient. The excellent cosmetic appeal and preservation of body image makes this approach particularly attractive in children and young adults.

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Surgical Approaches to the Blalock Shunt

Cited by 17 publications

References 11 publications

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

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

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

Strictly-posterior thoracotomy: a minimal-access approach for construction of the modified Blalock-Taussig shunt in West African children

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