The short- and long-term effect of Blalock-Taussig shunt size on the outcome after first palliative surgery for cyanotic heart diseases.

Abstract

BACKGROUND AND OBJECTIVESThe Blalock–Taussig (BT) shunt is regarded a safe and effective means increasing pulmonary blood flow for cyanotic heart conditions. The evaluation of shunt size for postoperative hemodynamics and until second-stage palliation remains difficult. Our objective is to compare the effect of different shunt sizes on short- and long-term outcomes after a BT shunt surgery.DESIGN AND SETTINGSThis is a retrospective review in a tertiary care hospital.PATIENTSThe records of all patients with a modified BT shunt between January 2007 and January 2010 were reviewed.METHODSPatients were divided into 2 groups: Group A with a BT shunt of 3.5 mm and Group B with a BT shunt of 4 mm, and their body weight was less than 4 kg. Groups were compared for the short-term outcome, which includes: intensive care unit course, intensive care unit (ICU) and hospital stay, mortality during the same admission, and the size of branch pulmonary arteries (PAs) before second surgery.RESULTSA total of 29 (42%) patients were in Group A and 40 (58%) in Group B. There was no significant difference in the mean weight between both groups; P value .06. There was no significant difference between the 2 groups in regard to diastolic blood pressure and lactate levels by the end of the first 48 hours after surgey. Group A required longer duration of inotropes and more days of ventilation with P value .03 and .001, respectively. The mean (standard deviation) ICU and hospital stay were 10.0 (8.9) days and 17.0 (11.4) days, respectively, for Group A and 12 (8.9) days and 15 (12.9) days, respectively, for Group B with P value .7 and P value .6, respectively. Yet Group B had a better branch PA size and required lesser intervention for branch PAs in comparison to Group A.CONCLUSIONThese data suggest that a smaller shunt size may have a trend toward higher morbidity. A bigger shunt size does not necessairly lead to stealing phenomena and its consequnces, and can be performed with a low risk leading to a better growth of branch PAs.