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Published on: May 7, 2015
Disease-specific outcome analysis of palliation with the modified Blalock-Taussig shunt
Thierry Bove1, Kristof Vandekerckhove2, Joseph Panzer2
1Department of Cardiac Surgery, University Hospital of Ghent, Ghent, Belgium thierry.bove@ugent.be.
Background:
Albeit being a simple surgical procedure, adverse outcomes with the modified Blalock-Taussig shunt (MBTS) are commonly reported in generalizing terms, independent of the underlying heart disorder.
Methods:
From August 1995 to December 2013, a total of 150 children underwent an MBTS for tetralogy of Fallot (TOF; n = 44, 29%), pulmonary atresia with ventricular septal defect (PA/VSD; n = 28, 19%), pulmonary atresia with intact ventricular septum (PA/IVS; n = 17, 11%), transposition of the great arteries with ventricular septal defect (TGA/VSD) with pulmonary stenosis (PS; n = 12, 8%), Ebstein malformation (n = 2, 1%), and complex univentricular anomalies (n = 47, 31%). Outcome analysis focused on operative mortality and survival until shunt takedown, adjusted to the underlying disease.
Results:
In-hospital mortality was 8.7% (n = 13), and interstage mortality was 5.1% (n = 7), resulting in 86.1% survival to the next surgery. Hospital mortality was 14% in PA/VSD, 13% in univentricular heart, and 18% in PA/IVS, while no mortality was observed in TOF, TGA/VSD/PS, and Ebstein disease. A shunt-related complication was observed in 18% (n = 27) of the children, including acute thrombosis (n = 7, 5%), shunt stenosis (n = 3, 2%), overshunting (n = 7, 5%), and pulmonary artery stenosis (n = 10, 7%). Multivariate analysis of shunt-dependent time survival identified a shunt complication occurring in a univentricular circulation (hazard ratio [HR] 4.10, 95% confidence interval [CI] = 1.05-17.43, P = .01) and increased shunt size-to-weight ratio (HR 2.72, 95% CI = 0.80-9.18, P = .04) as risk factors. Shunt thrombosis was also a negative outcome predictor in PA/VSD, when requiring associated unifocalization (P = .05).
Conclusion:
This study shows that the outcome of palliation with the MBTS is importantly affected by the occurrence of a shunt-related complication, whose circulatory effect is even more dismal in single ventricle hearts. Since an increased shunt size-to-weight ratio additionally compromises the shunt-dependent survival, it emphasizes that the choice of the shunt with regard to size as well as surgical approach remains critical.
Insights
Adverse outcomes after the modified Blalock-Taussig shunt (MBTS) in children are linked to shunt complications, especially in single ventricle hearts. Careful shunt selection and surgical approach are critical for better survival.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Vascular Surgery
Background:
- The modified Blalock-Taussig shunt (MBTS) is a common palliative procedure for complex congenital heart defects.
- Adverse outcomes are frequently reported but often generalized, lacking specific disease correlation.
Purpose of the Study:
- To analyze the outcomes of MBTS in pediatric patients with various congenital heart disorders.
- To identify risk factors for mortality and complications following MBTS.
Main Methods:
- Retrospective analysis of 150 children undergoing MBTS from 1995 to 2013.
- Outcome assessment included operative mortality, interstage mortality, and survival to shunt takedown.
- Multivariate analysis was used to identify predictors of shunt-dependent survival.
Main Results:
- Overall in-hospital mortality was 8.7% and interstage mortality was 5.1%, with 86.1% survival to the next surgery.
- Shunt-related complications occurred in 18% of patients, including thrombosis, stenosis, and overshunting.
- Complications in single ventricle hearts (HR 4.10) and increased shunt size-to-weight ratio (HR 2.72) were significant risk factors for mortality.
Conclusions:
- Shunt-related complications significantly impact MBTS outcomes, particularly in single ventricle physiology.
- Optimizing shunt size and surgical technique is crucial for improving survival in shunt-dependent patients.
