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Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations
Malenke Gedicke1, Gareth Morgan, Andrew Parry
1Bristol Congenital Heart Centre, Bristol Royal Hospital for Children, UK.
Insights
Acute blockage of modified Blalock-Taussig shunts (MBTS) occurred in 11.8% of patients within 24 hours. High preoperative hemoglobin, low weight (<3kg), and duct patency were key risk factors.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Vascular Surgery
Background:
- Modified Blalock-Taussig shunts (MBTS) are crucial palliative procedures for cyanotic congenital heart disease.
- Acute shunt blockage is a significant early complication, but associated risk factors are not well-defined.
Purpose of the Study:
- To investigate outcomes in pediatric patients following MBTS insertion.
- To identify risk factors associated with acute shunt blockage in the early postoperative period.
Main Methods:
- Retrospective study of 76 children undergoing their first MBTS for cyanotic congenital heart disease (2002-2006).
- Analysis of patient demographics, shunt characteristics, and early postoperative outcomes, including shunt patency.
Main Results:
- The rate of acute shunt blockage was 11.8% (9/76), occurring within the first 24 hours post-surgery.
- Significant risk factors for blockage included preoperative high hemoglobin levels, patient weight less than 3 kg, and patent ductus arteriosus on postoperative echocardiogram.
- Three early deaths (3.9%) occurred, unrelated to shunt blockage.
Conclusions:
- High preoperative hemoglobin, low perioperative weight, and ductal patency are significant risk factors for acute MBTS blockage.
- Further research is warranted to explore interventions like hemoglobin reduction and management of ductal patency to improve outcomes.
Abstract:
Factors relating to acute blockage of modified Blalock-Taussig shunts (MBTS) have not been well described in the literature. Our aim was to determine the outcomes in patients early after undergoing MBTS operations and to identify potential risk factors for acute shunt blockage in the early postoperative period. A retrospective study was performed in a tertiary referral congenital cardiac unit. All children who underwent first shunt insertion for cyanotic congenital heart disease during the study period from 2002 to 2006 were included. Seventy-six children underwent first shunt insertion with a median age of 37 days (range 2 days-8 years) and median weight of 3.75 kg (range 2.1-17.2 kg). The shunt sizes varied from 3 to 6 mm. The rate of acute shunt blockage was 11.8% (9/76), all within the first 24 h. There were 3 early deaths (3.9%), none of which were associated with shunt blockage. The main risk factors for blockage were preoperative high hemoglobin, weight less than 3 kg, and duct patency on echocardiogram after surgery. This study identifies that high preoperative hemoglobin, a weight less than 3 kg at operation, and the presence of a patent duct are statistically significant risk factors for shunt blockage in the acute postoperative period. Further work is needed to determine if reduction in preoperative hemoglobin concentration and attempts to reduce postoperative ductal patency may alter the outcome.