Effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GE Tongkai ,  CHEN Jimei , ZHUANG Jian , CEN Jianzheng , WEN Shusheng , XU Gang , LUO Dandong

Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academic of Medical Science, Guangzhou, 510080, P.R.China;

Corresponding?author：

CHEN Jimei, Email: jimei1965@gmail.com

Keywords：

Neonates; modified Blalock-Taussig shunt; congenital heart disease; surgery; treatment

DOI：

10.7507/1007-4848.201910049

Video：

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Objective To analyze the effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates.Methods The clinical data of 33 neonates undergoing modified Blalock-Taussig shunt between January 1, 2013 and December 31, 2017 were reviewed, including 28 males and 5 females with the age of 3.0-28.0 (18.0±6.1) d and weight of 1.9-3.7 (2.9±0.5) kg.Results There were 3 (9.1%) in-hospital deaths. Ten (30.3%) patients required early unplanned reoperations after surgery. Five (15.2%) patients were lost to follow-up. In the multivariate analysis, preoperative acidosis, emergency operation and postoperative bedside thoracotomy were independent risk factors of early death. During the follow-up of 18.0-93.0 (40.2±22.5) months, there was no death and 9 (36.0%) survival patients underwent corrective surgery and stage-two palliative surgery. In the multivariate analysis, preoperative hyperhemoglobinemia was an independent risk factor of nonadministration of the corrective surgery and stage-two palliative surgery. Receiver operating characteristic curve showed that preoperative hyperhemoglobinemia was significant in determining whether secondary surgery was possible.Conclusion The modified Blalock-Taussig shunt is effective in promoting development of pulmonary arteries and preparing for the secondary surgery. The rate of mortality and postoperative complications after the neonatal modified Blalock-Taussig shunt remains high. The rate of secondary surgery is still low during follow-up.

Citation： GE Tongkai, CHEN Jimei, ZHUANG Jian, CEN Jianzheng, WEN Shusheng, XU Gang, LUO Dandong. Effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(7): 737-741. doi: 10.7507/1007-4848.201910049 Copy

1.	O'Connor MJ, Ravishankar C, Ballweg JA, et al. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg, 2011, 142(1): 106-112.
2.	Alsoufi B, Gillespie S, Kogon B, et al. Results of palliation with an initial modified Blalock-Taussig shunt in neonates with single ventricle anomalies associated with restrictive pulmonary blood flow. Ann Thorac Surg, 2015, 99(5): 1639-1646.
3.	McKenzie ED, Khan MS, Samayoa AX, et al. The Blalock-Taussig shunt revisited: a contemporary experience. J Am Coll Surg, 2013, 216(4): 699-704.
4.	Bove T, Vandekerckhove K, Panzer J, et al. Disease-specific outcome analysis of palliation with the modified Blalock-Taussig shunt. World J Pediatr Congenit Heart Surg, 2015, 6(1): 67-74.
5.	Curzon CL, Milford-Beland S, Li JS, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg, 2008, 135(3): 546-551.
6.	Petrucci O, O'Brien SM, Jacobs ML, et al. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg, 2011, 92(2): 642-651.
7.	羅凱, 劉玉潔, 徐卓明, 等. 新生兒重癥復雜性先天性心臟病手術療效的影響因素. 中華胸心血管外科雜志, 2015, 31(3): 148-153.
8.	宓亞平, 賈兵, 李炘, 等. 室間隔完整型肺動脈閉鎖的臨床治療策略. 中華小兒外科雜志, 2009, 30(1): 20-24.
9.	Cheung EW, Richmond ME, Turner ME, et al. Pulmonary atresia/intact ventricular septum: influence of coronary anatomy on single-ventricle outcome. Ann Thorac Surg, 2014, 98(4): 1371-1377.
10.	Fenton KN, Pigula FA, Gandhi SK, et al. Interim mortality in pulmonary atresia with intact ventricular septum. Ann Thorac Surg, 2004, 78(6): 1994-1998.
11.	徐朝軍, 宋嵐, 尹曉清, 等. 改良 B-T 分流術在肺血減少型先天性心臟病中的臨床應用. 中國胸心血管外科臨床雜志, 2015, 22(5): 450-453.
12.	Shibata M, Itatani K, Oka N, et al. Optimal graft size of modified Blalock-Taussig shunt for biventricular circulation in neonates and small infants. Int Heart J, 2015, 56(5): 533-536.
13.	Myers JW, Ghanayem NS, Cao Y, et al. Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: analysis of shunt type, size, and surgical approach. J Thorac Cardiovasc Surg, 2014, 147(2): 672-677.
14.	?i?li E, Tuncer ON, ?enkaya S, et al. Blalock-Taussig shunt size: should it be based on body weight or target branch pulmonary artery size? Pediatr Cardiol, 2019, 40(1): 38-44.
15.	Ahmad U, Fatimi SH, Naqvi I, et al. Modified Blalock-Taussig shunt: immediate and short-term follow-up results in neonates. Heart Lung Circ, 2008, 17(1): 54-58.
16.	鄧喜成, 沈向東, 郭少先, 等. 姑息手術在肺動脈閉鎖合并室間隔缺損分期矯治中的應用. 中國胸心血管外科臨床雜志, 2011, 18(2): 104-108.
17.	王顯悅, 畢生輝, 王曉武, 等. 紫紺型先天性心臟病患者血紅蛋白增高的臨床意義. 西北國防醫學雜志, 2014, 35(4): 326-328.
18.	王顯悅, 畢生輝, 王曉武, 等. 血紅蛋白200g/L以上紫紺型先天性心臟病患者手術效果分析. 現代生物醫學進展, 2014, 14(7): 1308-1311.

1. O'Connor MJ, Ravishankar C, Ballweg JA, et al. Early systemic-to-pulmonary artery shunt intervention in neonates with congenital heart disease. J Thorac Cardiovasc Surg, 2011, 142(1): 106-112.
2. Alsoufi B, Gillespie S, Kogon B, et al. Results of palliation with an initial modified Blalock-Taussig shunt in neonates with single ventricle anomalies associated with restrictive pulmonary blood flow. Ann Thorac Surg, 2015, 99(5): 1639-1646.
3. McKenzie ED, Khan MS, Samayoa AX, et al. The Blalock-Taussig shunt revisited: a contemporary experience. J Am Coll Surg, 2013, 216(4): 699-704.
4. Bove T, Vandekerckhove K, Panzer J, et al. Disease-specific outcome analysis of palliation with the modified Blalock-Taussig shunt. World J Pediatr Congenit Heart Surg, 2015, 6(1): 67-74.
5. Curzon CL, Milford-Beland S, Li JS, et al. Cardiac surgery in infants with low birth weight is associated with increased mortality: analysis of the Society of Thoracic Surgeons Congenital Heart Database. J Thorac Cardiovasc Surg, 2008, 135(3): 546-551.
6. Petrucci O, O'Brien SM, Jacobs ML, et al. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg, 2011, 92(2): 642-651.
7. 羅凱, 劉玉潔, 徐卓明, 等. 新生兒重癥復雜性先天性心臟病手術療效的影響因素. 中華胸心血管外科雜志, 2015, 31(3): 148-153.
8. 宓亞平, 賈兵, 李炘, 等. 室間隔完整型肺動脈閉鎖的臨床治療策略. 中華小兒外科雜志, 2009, 30(1): 20-24.
9. Cheung EW, Richmond ME, Turner ME, et al. Pulmonary atresia/intact ventricular septum: influence of coronary anatomy on single-ventricle outcome. Ann Thorac Surg, 2014, 98(4): 1371-1377.
10. Fenton KN, Pigula FA, Gandhi SK, et al. Interim mortality in pulmonary atresia with intact ventricular septum. Ann Thorac Surg, 2004, 78(6): 1994-1998.
11. 徐朝軍, 宋嵐, 尹曉清, 等. 改良 B-T 分流術在肺血減少型先天性心臟病中的臨床應用. 中國胸心血管外科臨床雜志, 2015, 22(5): 450-453.
12. Shibata M, Itatani K, Oka N, et al. Optimal graft size of modified Blalock-Taussig shunt for biventricular circulation in neonates and small infants. Int Heart J, 2015, 56(5): 533-536.
13. Myers JW, Ghanayem NS, Cao Y, et al. Outcomes of systemic to pulmonary artery shunts in patients weighing less than 3 kg: analysis of shunt type, size, and surgical approach. J Thorac Cardiovasc Surg, 2014, 147(2): 672-677.
14. ?i?li E, Tuncer ON, ?enkaya S, et al. Blalock-Taussig shunt size: should it be based on body weight or target branch pulmonary artery size? Pediatr Cardiol, 2019, 40(1): 38-44.
15. Ahmad U, Fatimi SH, Naqvi I, et al. Modified Blalock-Taussig shunt: immediate and short-term follow-up results in neonates. Heart Lung Circ, 2008, 17(1): 54-58.
16. 鄧喜成, 沈向東, 郭少先, 等. 姑息手術在肺動脈閉鎖合并室間隔缺損分期矯治中的應用. 中國胸心血管外科臨床雜志, 2011, 18(2): 104-108.
17. 王顯悅, 畢生輝, 王曉武, 等. 紫紺型先天性心臟病患者血紅蛋白增高的臨床意義. 西北國防醫學雜志, 2014, 35(4): 326-328.
18. 王顯悅, 畢生輝, 王曉武, 等. 血紅蛋白200g/L以上紫紺型先天性心臟病患者手術效果分析. 現代生物醫學進展, 2014, 14(7): 1308-1311.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of modified Blalock-Taussig shunt on the treatment of cyanotic congenital heart diseases in neonates

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