Daffa Ikhwani Adli, Rayhan Amar, Wardoyo Suprayitno
Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Turk Gogus Kalp Damar Cerrahisi Derg. 2025 Jul 21;33(3):329-340. doi: 10.5606/tgkdc.dergisi.2025.26521. eCollection 2025 Jul.
In this systematic review and meta-analysis, we discuss the estimated of global incidence, shunt related-mortality risk and factors associated with shunt blockage after modified Blalock-Taussig-Thomas (mBTT) procedure.
A systematic review and meta-analysis were conducted using PubMed, ScienceDirect, and EMBASE up to February 2024. The primary outcomes were the incidence and mortality risk associated with shunt blockage. Additional outcomes included study characteristics, surgical factors, and coagulation profiles. Single and two-group proportional meta-analyses were performed.
A total of 25 studies involving 2,677 patients were included. The global incidence of shunt blockage was 7% (95% confidence interval [CI]: 0.05 to 0.10) with high heterogeneity ( =81%; p<0.01). In 15 studies eligible for mortality analysis, patients with shunt blockage had significantly higher odds of death (odds ratio [OR]=5.04; 95% CI: 2.69 to 9.44) with low heterogeneity ( =3%; p=0.41). Shunt size alone was not a significant predictor of blockage. However, patients with shunt blockage exhibited significantly lower partial thromboplastin time and activated partial thromboplastin time values, suggesting coagulation abnormalities. No significant difference was found in platelet counts.
Shunt blockage is a critical complication following mBTT shunt, significantly increasing mortality risk. While shunt size is not independently predictive, multiple factors, including patient weight, underlying pathology, coagulation profile, surgical factors, and shunt size-to-weight ratio, may contribute to thrombosis risk and warrant further investigation.
在本系统评价和荟萃分析中，我们探讨了改良布莱洛克 - 陶西格 - 托马斯（mBTT）手术后全球发病率、分流相关死亡风险以及与分流堵塞相关的因素估计值。
截至2024年2月，使用PubMed、ScienceDirect和EMBASE进行了系统评价和荟萃分析。主要结局是与分流堵塞相关的发病率和死亡风险。其他结局包括研究特征、手术因素和凝血指标。进行了单组和两组比例荟萃分析。
共纳入25项研究，涉及2677例患者。分流堵塞的全球发病率为7%（95%置信区间[CI]：0.05至0.10），异质性较高（I² = 81%；p < 0.01）。在15项符合死亡率分析条件的研究中，分流堵塞患者的死亡几率显著更高（优势比[OR] = 5.04；95% CI：2.69至9.44），异质性较低（I² = 3%；p = 0.41）。仅分流大小不是堵塞的显著预测因素。然而，分流堵塞患者的部分凝血活酶时间和活化部分凝血活酶时间值显著较低，提示存在凝血异常。血小板计数未发现显著差异。
分流堵塞是mBTT分流术后的一种关键并发症，显著增加死亡风险。虽然分流大小不是独立预测因素，但多种因素，包括患者体重、基础病理状况、凝血指标、手术因素和分流大小与体重比，可能导致血栓形成风险，值得进一步研究。
