Modified Blalock-Taussig shunts: to heparinize or not to heparinize?

OBJECTIVE

To demonstrate shunt function of modified Blalock-Taussig Shunts (MBTSs) when no heparin is administered postoperatively.

PATIENTS AND INTERVENTIONS

Twenty-four MBTSs were performed on 23 children with various congenital heart problems needing palliation before the primary repair could be completed. A single low dose of heparin was given intraoperatively and no heparin was given postoperatively. Patients were evaluated for shunt patency, bleeding problems and the incidence of significant seromas at the graft site.

MAIN RESULTS

There was one perioperative death and no incidence of early shunt failure. Two children died from causes unrelated to shunt function. There were no postoperative bleeding difficulties (no reoperations), and no seromas surrounding the grafts. Late follow-up (mean 18 +/- 1 months) revealed no shunt failure.

CONCLUSIONS

Avoidance of heparin after an MBTS procedure is a safe practice and may reduce bleeding problems and the incidence of significant seromas surrounding the graft. Postoperative shunt thrombosis is more likely related to intraoperative technical difficulty or extremely small pulmonary artery size.