Impact of Shunt/Pulmonary Artery Ratio on Outcomes in Modified Blalock-Taussig Shunt Patients

Mario Hendri RW; Arief Rakhman Hakim; Heroe Soebroto; Erdyanto Akbar; Hari Daswin Pagehgiri

doi:10.25163/angiotherapy.879817

Angiogenesis, Inflammation & Therapeutics | Online ISSN 2207-872X

RESEARCH ARTICLE (Open Access)

Previous Next Contents Vol 8 (7)

Impact of Shunt/Pulmonary Artery Ratio on Outcomes in Modified Blalock-Taussig Shunt Patients

Mario Hendri RW ^1*, Arief Rakhman Hakim ¹, Heroe Soebroto ¹, Erdyanto Akbar ¹, Hari Daswin Pagehgiri ¹

+ Author Affiliations

Journal of Angiotherapy 8 (7) 1-7 https://doi.org/10.25163/angiotherapy.879817

Submitted: 18 May 2024 Revised: 22 July 2024 Published: 25 July 2024

Abstract

Background: The modified Blalock-Taussig shunt (mBTT shunt) is a critical procedure for managing congenital heart defects by improving pulmonary circulation. Traditionally, shunt size is determined based on patient weight and standard guidelines. However, recent evidence indicates that the shunt size relative to the pulmonary artery diameter (S/PA ratio) may be a more accurate predictor of outcomes. This study evaluates the impact of the S/PA ratio on mortality and other clinical outcomes in patients undergoing the mBTT shunt. Methods: This retrospective study analyzed the medical records of 36 patients who underwent mBTT shunt at Soetomo General Academic Hospital between 2021 and 2023. Data on demographics, clinical characteristics, procedural details, and outcomes were collected, focusing on variables such as age, weight, McGoon ratio, pre- and post-operative SpO2 levels, and S/PA ratio. Statistical analyses included Chi-square tests for categorical variables and independent t-tests for continuous variables, with a p-value of <0.05 considered significant. Results: The cohort had a mean age of 54.81 months and a mean weight of 12.18 kg. Preoperative SpO2 averaged 71.44%, improving to 79.26% post-operatively. Patients with an S/PA ratio >1.00 had a significantly higher mortality rate (37.5%) compared to those with an S/PA ratio <1.00 (7.7%) (p = 0.029). These patients also experienced longer ICU stays (4.92 vs. 2.06 days, p = 0.005) and more ventilation days (3.40 vs. 1.68 days, p = 0.047). The hospital stay was also extended in the higher ratio group (8.60 vs. 5.50 days, p = 0.076). No significant differences were observed in pre- and post-operative SpO2 levels or inotropic use. Conclusion: A higher S/PA ratio is associated with increased mortality, longer ICU and hospital stays, and greater ventilation needs following the mBTT shunt. These findings suggest that optimizing shunt size relative to pulmonary artery diameter could lead to better outcomes. Further research is needed to confirm these results and refine surgical strategies for enhanced patient care.

Keywords: mBTT shunt, S/PA ratio, congenital heart defects, pulmonary circulation, surgical outcomes

References

Alahmadi, M. H., & Bishop, M. A. (2023). Modified Blalock-Taussig-Thomas Shunt. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK597363/

Amelia, P., Advani, N., Pulungan, A., Djer, M., Hegar, B., Prawira, Y., & Sukardi, R. (2023). Predicting Factors for Mortality in Patients After the Modified Blalock-Taussig Shunt Procedure in Developing Countries: A Retrospective Study. International Journal of General Medicine, Volume 16. https://doi.org/10.2147/ijgm.s432855

Elella, R. A., Umereta, N., Alabari, I., Al Ahmadi, M., & Al Wadai, A. (2014). The short- and long-term effect of Blalock-Taussig shunt size on the outcome after first palliative surgery for cyanotic heart diseases. Annals of Saudi Medicine, 34(6). https://doi.org/10.5144/0256-4947.2014.494

Kiran, U., Aggarwal, S., Choudhary, A., Uma, B., & Kapoor, P. (2017). The blalock and taussig shunt revisited. In Annals of Cardiac Anaesthesia (Vol. 20, Issue 3). https://doi.org/10.4103/aca.ACA_80_17

Küçük, M., Özdemir, R., Karaçelik, M., Doksöz, Ö., Karadeniz, C., Yozgat, Y., Mese, T., & Sariosmanoglu, O. N. (2016). Risk factors for thrombosis, overshunting and death in infants after modified blalock-Taussig shunt. Acta Cardiologica Sinica, 32(3). https://doi.org/10.6515/ACS20150731A

McMullan, D. M., Permut, L. C., Jones, T. K., Johnston, T. A., & Rubio, A. E. (2014). Modified Blalock-Taussig shunt versus ductal stenting for palliation of cardiac lesions with inadequate pulmonary blood flow. Journal of Thoracic and Cardiovascular Surgery, 147(1). https://doi.org/10.1016/j.jtcvs.2013.07.052

Need, L. R., Powell, A. J., Del Nido, P., & Geva, T. (2000). Coronary echocardiography in tetralogy of Fallot: Diagnostic accuracy, resource utilization and surgical implications over 13 years. Journal of the American College of Cardiology, 36(4). https://doi.org/10.1016/S0735-1097(00)00862-7

Oofuvong, M., Tanasansuttiporn, J., Wasinwong, W., Chittithavorn, V., Duangpakdee, P., Jarutach, J., & Yunuswangsa, Q. (2021). Predictors of death after receiving a modified Blalock-Taussig shunt in cyanotic heart children: A competing risk analysis. PLoS ONE, 16(1 January). https://doi.org/10.1371/journal.pone.0245754

Rana, B. S., Monaghan, M. J., Ring, L., Shapiro, L. S., & Nihoyannopoulos, P. (2011). The pivotal role of echocardiography in cardiac sources of embolism. European Journal of Echocardiography, 12(10). https://doi.org/10.1093/ejechocard/jer122

Shibata, M., Itatani, K., Oka, N., Yoshii, T., Nakamura, Y., Kitamura, T., Horai, T., & Miyaji, K. (2015). Optimal graft size of modified blalock-taussig shunt for biventricular circulation in neonates and small infants. International Heart Journal, 56(5). https://doi.org/10.1536/ihj.15-042

Tarca, A., Peacock, G., McKinnon, E., Andrews, D., & Saundankar, J. (2023). A Single-Centre Retrospective Review of Modified Blalock-Taussig Shunts: A 22-Year Experience. Heart Lung and Circulation, 32(3). https://doi.org/10.1016/j.hlc.2022.12.005

Vanderlaan, R. D., & Barron, D. J. (2023). Optimal Surgical Management of Tetralogy of Fallot. CJC Pediatric and Congenital Heart Disease, 2(6). https://doi.org/10.1016/j.cjcpc.2023.09.003

Yuan, S. M., Shinfeld, A., & Raanani, E. (2009). The blalock-taussig shunt: Short communication. Journal of Cardiac Surgery, 24(2), 101–108. https://doi.org/10.1111/j.1540-8191.2008.00758.x

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