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Standardized Perioperative Thrombosis Prevention in Neonatal Modified Blalock-Taussig Shunt Surgery: An
Valentin Stroe1,2, Lacramioara Eliza Chiperi2,3, Horatiu Suciu2,4
1Institution Organizing University Doctoral Studies, University of Medicine, Pharmacy, Science and Technology "George Emil Palade", 540142 Targu Mures, Romania.
Children (Basel, Switzerland)
|June 26, 2026
Summary
A new protocol for preventing early thrombosis in systemic-to-pulmonary artery shunts (SPS) in neonates showed promising results. The standardized approach maintained shunt patency without increasing bleeding complications in this small study.
Area of Science:
- Cardiovascular Surgery
- Neonatal Medicine
- Pediatric Cardiology
Background:
- Early thrombosis of systemic-to-pulmonary artery shunts (SPS) is a significant cause of mortality in neonates with duct-dependent pulmonary circulation.
- A universally accepted perioperative thrombosis prevention protocol for SPS placement is lacking.
- This study evaluates a standardized protocol for preventing early shunt thrombosis.
Purpose of the Study:
- To assess the early outcomes of a standardized perioperative thrombosis prevention protocol in neonates undergoing SPS placement.
- To determine the incidence of early shunt thrombosis within 30 days post-surgery.
- To evaluate the safety and feasibility of the protocol, including bleeding risks.
Main Methods:
- A single-center case series of nine neonates undergoing primary modified Blalock-Taussig shunt placement.
- Implementation of a standardized protocol: preoperative aspirin, intraoperative heparinization (ACT > 300s), meticulous shunt management, and early postoperative heparin/aspirin.
- Primary endpoint: early shunt thrombosis within 30 days.
Main Results:
- No early shunt thrombosis occurred in any of the nine neonates (0/9).
- No reinterventions, early mortality, major bleeding, or intracranial hemorrhage were observed.
- The protocol was applied despite prothrombotic risk factors in 33.3% of patients.
Conclusions:
- A standardized perioperative thrombosis prevention protocol was associated with preserved early shunt patency in neonates.
- The protocol demonstrated short-term safety without an increased bleeding risk.
- Findings support the feasibility of this strategy, though larger studies are needed to confirm effectiveness.
