Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Department of Pediatrics, Division of Pediatric Cardiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Ann Thorac Surg. 2022 Jul;114(1):168-175. doi: 10.1016/j.athoracsur.2021.11.003. Epub 2021 Nov 24.
The modified Blalock-Taussig-Thomas shunt is a critically important palliation for patients with insufficient pulmonary blood flow associated with congenital heart disease. After creating a modified Blalock-Taussig-Thomas shunt patients experience high rates of early postoperative morbidity and mortality.
This is a single-institution retrospective cohort study. A query of The Society of Thoracic Surgeons database identified relevant patients whose health records were manually queried for echocardiography and operative reports. Patients with ductal-dependent systemic circulation were excluded. Primary outcomes were early serious adverse events and in-hospital mortality. Secondary outcomes were time to primary outcomes and postoperative lengths of stay. We investigated the correlation of demographics, presence of competitive pulmonary blood flow, and surgical and anatomic factors on outcomes.
After exclusions our cohort comprised 155 patients. Thirty-three patients (21.3%) experienced an early serious adverse event, 10 (6.5%) early shunt malfunction, and 11 (7.1%) in-hospital mortality. Smaller shunt size, smaller shunted pulmonary artery size, surgical approach, and site of proximal shunt anastomosis were independently associated with morbidity and mortality.
Anatomic elements imparting increased resistance along the modified Blalock-Taussig-Thomas shunt predispose to increased morbidity and mortality, particularly in the early postoperative period. Despite the significant heterogeneity of patients receiving such shunts, similar risk profiles are observed regardless of lesion or presence of competitive flow. A surgical approach using thoracotomy with shunt anastomosis to the subclavian artery, where feasible, results in the subclavian artery as the point of natural resistance, allowing for placement of larger shunts and yielding lower morbidity and mortality.
改良的 Blalock-Taussig-Thomas 分流术是一种重要的姑息疗法，适用于患有先天性心脏病导致肺血流量不足的患者。在创建改良 Blalock-Taussig-Thomas 分流术后，患者会出现高早期术后发病率和死亡率。
这是一项单机构回顾性队列研究。通过对胸外科医师学会（STS）数据库进行查询，确定了相关患者，并对其病历进行了手动查询，以获取超声心动图和手术报告。排除依赖导管的体循环患者。主要结局是早期严重不良事件和院内死亡率。次要结局是主要结局的发生时间和术后住院时间。我们研究了人口统计学因素、竞争血流的存在以及手术和解剖因素对结果的相关性。
排除后，我们的队列包括 155 名患者。33 名患者（21.3%）发生早期严重不良事件，10 名患者（6.5%）早期分流器功能障碍，11 名患者（7.1%）院内死亡。分流器尺寸较小、分流肺动脉尺寸较小、手术方法和近端分流吻合部位与发病率和死亡率独立相关。
改良 Blalock-Taussig-Thomas 分流术的解剖因素会增加分流术的阻力，导致发病率和死亡率增加，尤其是在术后早期。尽管接受此类分流术的患者存在明显的异质性，但无论病变或竞争血流的存在如何，都观察到类似的风险特征。使用经胸廓切开术并将分流吻合至锁骨下动脉的手术方法（如果可行），使锁骨下动脉成为自然阻力点，从而可以放置更大的分流器，并降低发病率和死亡率。
