Sternotomy Approach for Modified Blalock-Taussig Shunt: Is it a Safe Option?

Central aorta-pulmonary artery shunts have fallen into disfavor because of shunt thrombosis and congestive heart failure, and a modified Blalock-Taussig shunt via thoracotomy can lead to pulmonary artery hypoplasia and distortion. We reviewed the outcomes of a modified Blalock-Taussig shunt by a sternotomy approach in 20 infants from July 2007 to October 2009. Their mean age was 5.79 months, and median weight was 5.4 kg. A 4-mm graft was placed in 11 patients, a 5-mm graft in 8, and a 3.5-mm graft in 1. There was no incidence of sepsis, seroma, or phrenic nerve palsy. There was one hospital death. The mean hospital stay was 10.4 ± 4.3 days (range, 8–15 days). The mean oxygen saturation at discharge was 89% (range, 81%–93%). The sternotomy approach is technically easier to perform, cosmetically preferable, and probably hemodynamically superior. Correction of branch pulmonary stenosis is easily incorporated into this procedure. The theoretical disadvantage of this method is a potential technical difficulty with sternal reentry for subsequent procedures.

[1]  M. Jeong,et al.  Randomized comparison of cilostazol vs clopidogrel after drug-eluting stenting in diabetic patients--clilostazol for diabetic patients in drug-eluting stent (CIDES) trial. , 2008, Circulation Journal.

[2]  Pramod Reddy,et al.  Neonatal Blalock-Taussig Shunt: Technical Aspects and Postoperative Management , 2008, Asian cardiovascular & thoracic annals.

[3]  J E Mayer,et al.  Sternotomy approach for the modified Blalock-Taussig shunt. , 1995, Circulation.

[4]  P. Vouhé,et al.  Modified Blalock-Taussig shunts: results in infants less than 3 months of age. , 1990, The Annals of thoracic surgery.

[5]  J J Amato,et al.  Systemic-pulmonary polytetrafluoroethylene shunts in palliative operations for congenital heart disease. Revival of the central shunt. , 1988, The Journal of thoracic and cardiovascular surgery.

[6]  R. Jonas,et al.  First-stage palliation of hypoplastic left heart syndrome. The importance of coarctation and shunt size. , 1986, The Journal of thoracic and cardiovascular surgery.

[7]  J. Brenner,et al.  Classic versus modified Blalock-Taussig shunts in neonates and infants. , 1985, Circulation.

[8]  S. Pappelbaum,et al.  Systemic-pulmonary shunts in infants and children. Early and late results. , 1984, The Journal of thoracic and cardiovascular surgery.

[9]  H. Taussig,et al.  Landmark article May 19, 1945: The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. By Alfred Blalock and Helen B. Taussig. , 1984, JAMA.

[10]  C. Byrum,et al.  Subclavian-pulmonary artery shunts with polytetrafluorethylene interposition grafts. , 1984, The Annals of thoracic surgery.

[11]  P. Kay,et al.  Experience with the modified Blalock-Taussig operation using polytetrafluoroethylene (Impra) grafts. , 1983, British heart journal.

[12]  F. Macartney,et al.  Modified Blalock-Taussig shunt. Use of subclavian artery orifice as flow regulator in prosthetic systemic-pulmonary artery shunts. , 1981, The Journal of thoracic and cardiovascular surgery.

[13]  Z. Farooki,et al.  Results of two-stage surgical treatment of tetralogy of Fallot. , 1980, The Journal of thoracic and cardiovascular surgery.

[14]  V. Willman,et al.  The Blalock-Taussig shunt in the neonate. , 1978, The Annals of thoracic surgery.

[15]  R. Bartlett,et al.  Microporous expanded polytetrafluoroethylene arterial prosthesis for construction of aortopulmonary shunts: experimental and clinical results. , 1976, The Annals of thoracic surgery.

[16]  Cooley Da,et al.  Intrapericardial aortic-right pulmonary arterial anastomosis. , 1966 .

[17]  D. Cooley,et al.  Intrapericardial aortic-right pulmonary arterial anastomosis. , 1966, Surgery, gynecology & obstetrics.

[18]  M. A. Engle,et al.  The effects of ligation of the subclavian artery on the bones and soft tissues of the arms. , 1965, The Journal of pediatrics.

[19]  J. Mclaughlin,et al.  The distribution of pulmonary blood flow after subclavian-pulmonary anastomosis. An experimental study. , 1965, The Journal of thoracic and cardiovascular surgery.

[20]  D. Waterston.  [Treatment of Fallot's tetralogy in children under 1 year of age]. , 1962, Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti.

[21]  W. Potts,et al.  Anastomosis of the aorta to a pulmonary artery in certain types of congenital heart disease. , 1946, Case reports. Children's Memorial Hospital.

[22]  H. Taussig,et al.  The Surgical Treatment of Malformations of the Heart: In Which There Is Pulmonary Stenosis or Pulmonary Atresia , 1945 .