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Modified Blalock Taussig shunt: comparison between neonates, infants and older children
Sarvesh Pal Singh1, Sandeep Chauhan, Minati Choudhury
1Department of Cardiac Anesthesia, Cardio-Thoracic Sciences Center, All India Institute of Medical Sciences, New Delhi, India.
Insights
Neonates undergoing Modified Blalock Taussig shunt (MBTS) face higher risks. Key predictors of mortality include young age, low weight, and prolonged ventilation post-surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Neonatal Intensive Care
Background:
- The Modified Blalock Taussig shunt (MBTS) is a critical palliative procedure for complex congenital heart diseases.
- Understanding risk factors and outcomes in different pediatric age groups is essential for surgical planning and patient care.
Purpose of the Study:
- To compare pre- and post-operative parameters in neonates, infants, and older children undergoing MBTS.
- To identify independent predictors of mortality in pediatric patients after MBTS.
Main Methods:
- Retrospective review of 134 children who underwent MBTS via thoracotomy over two years.
- Categorization of patients into neonates, infants, and older children for comparative analysis.
- Recording and analysis of pre- and post-operative variables, including complications and mortality.
Main Results:
- Post-operative improvements in PaO2 and SaO2 were significant and similar across all age groups.
- Neonates experienced significantly higher requirements for adrenaline, longer ventilation durations, and increased mortality.
- Overall mortality was 4.5%, with infant mortality at 8%.
Conclusions:
- Neonates represent a high-risk group for MBTS, exhibiting greater complications and mortality compared to older children.
- Independent predictors of mortality include age less than 30 days, weight under 3 kg, packed red blood cell transfusion exceeding 6 ml/kg, mechanical ventilation longer than 24 hours, and a post-shunt PaO2 increase below 25% of baseline.
Objective:
The aim was to compare various pre-and post-operative parameters and to identify the predictors of mortality in neonates, infants, and older children undergoing Modified Blalock Taussig shunt (MBTS).
Materials And Methods:
Medical records of 134 children who underwent MBTS over a period of 2 years through thoracotomy were reviewed. Children were divided into three groups-neonates, infants, and older children. For analysis, various pre-and post-operative variables were recorded, including complications and mortality.
Results:
The increase in PaO 2 and SaO 2 levels after surgery was similar and statistically significant in all the three groups. The requirement of adrenaline, duration of ventilation and mortality was significantly higher in neonates. The overall mortality and infant mortality was 4.5% and 8%, respectively.
Conclusion:
Neonates are at increased risk of complications and mortality compared with older children. Age (<30 days), weight (<3 kg), packed red blood cells transfusion >6 ml/kg, mechanical ventilation >24 h and post shunt increase in PaO 2 (P Diff) <25% of baseline PaO 2 are independent predictors of mortality in children undergoing MBTS.
