Open Access

ARTICLE

Outcomes of Blalock-Taussig shunts in current era: A single center experience

Navaneetha Sasikumar, Antony Hermuzi, Chun-Po Steve Fan, Kyong-Jin Lee, Rajiv Chaturvedi, Edward Hickey, Osami Honjo, Glen S. Van Arsdell, Christopher A. Caldarone, Arnav Agarwal, Lee Benson

Department of Pediatrics, The Labatt Family Heart Center, Division of Cardiology, The University of Toronto School of Medicine, Toronto, Canada

* Corresponding Author: Lee Benson, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada, M5G 1X8. Email:

Congenital Heart Disease 2017, 12(6), 808-814. https://doi.org/10.1111/chd.12516

Abstract

Objectives: Mortality associated with the modified Blalock–Taussig shunt (MBTS) remains high despite advanced perioperative management. This study was formulated to provide data on (1) current indications, (2) outcomes, and (3) factors affecting mortality and morbidity.
Design: A retrospective single center chart review identified 95 children (excluding hypoplastic left heart lesions) requiring a MBTS. Mortality and major morbidity were analyzed using the Kaplan Meier method and risk factor analysis using Cox’s proportional hazard regression.
Results: Median age was 8 (0–126) days, weight 3.1(1.7–5.4) kg. Seventy-three percent were neonates, 58% duct dependent and 73% had single ventricle physiology. Ninety-seven percent had a sternotomy approach for shunt placement with 70% receiving a 3.5 mm graft. Mean graft index (shunt cross sectional area [mm² ]/BSA [m² ]) was 44.39 ± 8.04 and shunt size (mm) to body weight (kg) ratio 1.1 ± 0.2. Hospital mortality was 12%, with an interval mortality of 6%. Shunt thrombosis/stenosis occurred in 23% and pulmonary over circulation in 30%, while shunt reoperation was required in 12% and catheter intervention in 8% of the cohort. At 1-year, survival was 82.0% (95% CI [72.7%, 88.4%]), and survival free of major morbidity 61.4% (95% CI [50.7%, 70.5%]). Duct dependency predisposed to mortality (P = .01, HR 6.74 [1.54, 29.53]) and composite outcome (mortality and major morbidity) (P = .04, HR 2.15, CI [1.036, 4.466]) and higher graft index to mortality (P = .005, HR 1.07 [1.02, 1.12]).
Conclusions: The commonest indication for a MBTS in the current era was single ventricle palliation. Morbidity and mortality was considerable, partly explained by the higher at risk population. Alternative methods to maintain pulmonary blood flow in place of a MBTS requires further investigation.

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