Reduced Perioperative Bleeding With Use of Saphenous Vein Homograft as Blalock-Taussig-Thomas Shunt

Polytetrafluoroethylene (PTFE), traditionally used for construction of Blalock-Taussig-Thomas (BTT) shunt, is associated with complications such as perioperative bleeding, thrombosis, and stenosis. Saphenous vein homografts (SVHs) are theoretically more hemostatic and less thrombogenic.

A retrospective chart review was conducted of all infants who underwent BTT shunt placement between January 2015 and May 2023 to compare the use of blood and blood products in the operating room and within the first 24 hours after cardiac intensive care unit admission. Morbidity (unplanned reoperations, extracorporeal membrane oxygenation requirement, or dialysis) was also compared.

Of 78 infants who underwent BTT shunt placement, 26 (33%) received SVH and 52 (67%) received PTFE. Patients receiving SVH were more often premature (30.8% vs 15.4%; standardized mean difference [SMD], 0.37) and had more extracardiac anomalies (15.4% vs 5.8%; SMD, 0.32). Cardiopulmonary bypass times were longer with SVH (median, 102 [interquartile range, 89-113] minutes vs 68 [interquartile range, 55-89] minutes; SMD, 0.84). Multivariable regression analysis demonstrated a decreased requirement for blood (adjusted coefficient, -42.7; 95% CI, -59.1 to -26.2; P < .001) and blood products (adjusted coefficient, -19.8; 95% CI, -33 to -6.6; P = .004) with SVH. There were no group differences in rate of shunt thrombosis or need for percutaneous intervention. Interstage mortality (8% vs 13%) and morbidity (8% vs 10%) were similar, as were hemodynamic data before shunt takedown.

SVH as BTT shunt is associated with significantly less perioperative bleeding compared with PTFE, with no differences in risk of thrombosis or need for percutaneous intervention.