Abstract

BackgroundThe original approach to performing a modified Blalock-Taussig (MBT) shunt is via a left thoracotomy. However, the median sternotomy has become the preferred approach of many surgeons. We think that the upper ministernotomy approach provides several advantages and avoids the disadvantages of both the sternotomy and thoracotomy approaches. Here, we describe our experience in constructing neonatal MBT shunts via upper ministernotomy.MethodsA prospective study was conducted on 50 neonates who underwent modified Blalock-Taussig shunt performed through upper ministernotomy between March 2011 and December 2016. Preoperative characteristics, mortality, and morbidity were recorded.ResultsMean age was 16.9 ± 10.4 days, and weight was 3.5 ± 0.5 kg. All patients received grafts of size 3.5 mm. The mean oxygen saturation increased from 59.5 ± 7.3% preoperatively to 84.8 ± 4.2% postoperatively. There were three cases of mortality (6%). One patient suffered from an unstable sternum (2%). No patients required conversion to full sternotomy. Superficial wound infection occurred in three cases (6%), and there were no cases of mediastinitis. Mean duration of ventilation was 55.64 ± 37.5 h, mean ICU stay was 5.44 ± 3.9 days, and mean hospital stay was 14.7 ± 7.2 days.ConclusionUpper ministernotomy is a safe approach with good early results. It provides adequate exposure with limited surgical trauma. Emergency conversion to full sternotomy and initiation of cardiopulmonary bypass can be achieved easily. It avoids lung compression and respiratory compromise. Additional costs for specific instruments are not necessary.

Highlights

  • The original approach to performing a modified Blalock-Taussig (MBT) shunt is via a left thoracotomy

  • We study the feasibility of MBT shunt construction in neonates via upper ministernotomy

  • All neonates who presented with desaturation due to decreased pulmonary blood flow and scheduled for an MBT shunt were included in the study

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Summary

Introduction

The original approach to performing a modified Blalock-Taussig (MBT) shunt is via a left thoracotomy. The modified Blalock-Taussig (MBT) shunt was introduced as one of many options for connecting the systemic and pulmonary circulations and involves a polytetrafluorethylene (PTFE) tube graft being inserted between the subclavian and pulmonary arteries. It has become a widely accepted palliative procedure due to the low morbidity and mortality rates associated with the procedure [1–3]. Some of the reasons for this include the following: Midany and Doghish The Cardiothoracic Surgeon (2019) 27:1 it is a less demanding operation, it provides greater control of the blood vessels without the risk of respiratory compromise due to lung compression, and it enables construction of the anastomosis at the side of the superior vena cava for possible correction of pulmonary artery distortion during later conversion to the bidirectional Glenn [5]. Subsequent procedures require repeat sternotomy, which is more time consuming and carries greater risk due to sternal adhesions

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