The Impact of Shunt Type on Palliative Outcomes in Neonates and Infants With Diminished Pulmonary Blood Flow

Abstract

We analyzed early and intermediate outcomes in cyanotic neonates (n = 43) and infants (n = 26) requiring palliation with either a modified Blalock-Taussig shunt (MBT) or a central aortopulmonary shunt (CAP). Between 1995 and 2009, 69 consecutive patients underwent an MBT (n = 42) or CAP (n = 27) for tetralogy of Fallot (n = 21), pulmonary atresia (n = 25), severe pulmonary valve stenosis (n = 22), and 2-stage repair of transposition of the great arteries (n = 1). The groups were similar with regard to age, weight, pulmonary artery diameter, and preoperative saturations. Postoperative mortality was 3 after CAP (11.1%) versus 1 after MBT (2.4%; P = .0203). Shunt size/weight index was comparable for both groups. MBTs had shorter surgical times (P = .002), required less inotropes (inotropic index, 103 ± 18 vs 889 ± 199; P = .0069), less blood product transfusions (P = .01), and had shorter duration of ventilation (P = .026) and intensive care unit (ICU) stay (P = .042). Children with MBTs had higher saturations at hospital discharge (P = .018). Prior to complete repair, 2 patients with a CAP and 10 patients after an MBT needed pulmonary artery dilation or stent implantation (P = .23). At the time of complete repair and shunt takedown, 3 MBT patients needed surgical patch augmentation of the pulmonary artery. The MBT is a safer and more expeditious operation and more frequently avoids cardiopulmonary bypass. Patients require less inotropes, blood products, and ICU time but may require more interventional therapy to treat pulmonary artery stenosis in the interval to complete repair. Surgical treatment of shunt-related pulmonary artery distortion may be addressed at the time of complete repair.