Introduction
This single-centre retrospective study explores demographics and outcomes of patients
who underwent a modified Blalock-Taussig shunt (MBTS) over a 22-year period. The predominant
surgical approach in this study is a lateral thoracotomy, in contrast to a midline
sternotomy. Risks and outcomes of this approach are compared with national and international
literature.
Materials and Methods
Demographic, anatomical, clinical, surgical and outcome data of all patients who underwent
a MBTS between 2000 and 2022 were collected and analysed, excluding Norwood procedures,
which are not performed at this institution. Short- and long-term morbidity and mortality
is described.
Results
Over the 22-year study period, 185 MBTS were performed in 162 patients, at a median
age of 16 days (interquartile range [IQR] 5–59 days) and weight of 3.47 kg (IQR 3–4.25
kg, minimum weight 2 kg). Of these, 79% of patients had a biventricular circulation.
Cardiac diagnoses included both univentricular and biventricular anatomy; tetralogy
of Fallot (TOF) (36%), transposition of the great arteries/ventricular septal defect/pulmonary
stenosis (TGA/VSD/PS) (11%), pulmonary atresia with intact ventricular septum (PA/IVS)
(23%), pulmonary atresia with ventricular septal defect (PA/VSD) (14%), other (16%).
The most common size of MBTS was 4 mm (71%); 93% were performed via a lateral thoracotomy.
There were 47 cases of major operative morbidity, which did not differ significantly
with cardiac diagnosis. Overall all-cause mortality was 13.5%. Early operative mortality
was 4.3%. Mortality varied with cardiac diagnosis, 6% with TOF and 19% with PA/IVS.
There was no era effect on mortality rates, however a lower frequency of major morbidity
(23% vs 7%, p=0.03) was observed in the most recent third of the study period. Risk
factors for shunt reintervention or mortality included weight <2.5 kg (HR=2.79 [1.37,
5.65], p=0.005), and pre- (HR=3.31 [1.86, 5.9], p<0.001) or postoperative lactic acidosis
(HR=1.37 [1.25,1.5], p<0.001). These rates are comparable to those in the literature,
with the predominant approach a midline sternotomy.
Conclusion
Mortality rates and risk factors for adverse outcomes are comparable to those previously
reported for both univentricular and biventricular groups. These results highlight
that outcomes of MBTS performed via lateral thoracotomy are comparable to those by
midline sternotomy as reported in the literature. Operating via the lateral approach
may be advantageous as it avoids the complications of a midline sternotomy.
Keywords
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Article info
Publication history
Published online: January 06, 2023
Accepted:
December 7,
2022
Received in revised form:
November 21,
2022
Received:
August 3,
2022
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
