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[Long-term results of the Blalock-Taussig shunts]
N Yoshimura1, M Yamaguchi, H Ohashi
1Department of Cardio-Thoracic Surgery, Kobe Children's Hospital, Japan.
Insights
The classical Blalock-Taussig shunt demonstrated a low operative mortality of 0.7% in 136 patients. Polydioxanone suture (PDS) may enhance anastomotic growth in Blalock-Taussig operations.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Surgical Techniques
Context:
- The Blalock-Taussig shunt is a palliative procedure for cyanotic congenital heart disease.
- Between 1980 and 1990, 136 patients underwent classical Blalock-Taussig shunts.
- Patient ages ranged from 4 days to 12.8 years, with a median of 13 months.
Purpose:
- To evaluate the outcomes and long-term efficacy of the classical Blalock-Taussig shunt.
- To assess the need for re-interventions and corrective surgeries post-shunt.
- To investigate the potential benefits of polydioxanone suture (PDS) in Blalock-Taussig shunts.
Summary:
- Operative mortality was 0.7%, with a 5.4-year average follow-up.
- 91.0% and 76.4% of patients remained well-palliated at 1 and 3 years post-operation, respectively.
- Vascular anastomotic stenosis occurred in 49.3% of patients; PDS may improve anastomotic growth.
Impact:
- The classical Blalock-Taussig shunt offers a low-risk palliative option for complex congenital heart defects.
- Further research into PDS use could optimize shunt longevity and reduce re-intervention rates.
- This study provides valuable long-term data on shunt patency and patient outcomes.
Abstract:
One-hundred and thirty-six patients received the classical Blalock-Taussig shunts between 1980 and 1990. Their age range at operation was 4 days to 12.8 years and their median age was 13 months. The operative mortality rate was 0.7% (1/136). The survivors were followed up from 1 month to 11.5 years, 5.4 years in average. Twenty-five patients required another shunt and the mean interval to that procedure was 2.4 years (modified Blalock-Taussig 23, classical Blalock-Taussig 2, Glenn 1, internal mammary artery-pulmonary artery shunt 1). Forty-five patients received corrective operations, there were four operative deaths (Fontan 2, Rastelli 2). There were 15 late deaths of which three deaths were not cardiogenic. One year after operation, 91.0% of patients remained in well-palliated condition. At three years after operation, 76.4% of patients continued to be in well-palliated condition. There were twelve neonates in this series. Their age range was 4 to 26 days and their median age was 13 days. There was no operative death. Five patients required second shunt. There were two late deaths. At present, six patients continue to be in well-palliated condition 8 months to 9 years after first operation. Angiographic findings showed the stenotic change of the vascular anastomoses in 49.3% (35/71) of patients. This study suggests that polydioxanone suture (PDS) will be useful for the growth of the anastomoses in Blalock-Taussig operation.