Al Jubair K A, Al Fagih M R, Al Jarallah A S, Al Yousef S, Ali Khan M A, Ashmeg A, Al Faraidi Y, Sawyer W
Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Cardiol Young. 1998 Oct;8(4):486-90. doi: 10.1017/s1047951100007150.
Between 1983 and 1995, 546 Blalock-Taussig shunt procedures were performed in 472 patients: 128 (23.0%) were classical shunts, 90 of them on the same side as to the aortic arch, and 418 (77.0%) were modified shunts, 182 on the same side of the arch. At the time of surgery, 78 patients were aged below one week, 270 from one week to 12 months, and 198 patients were over one year of age. The mean pre-operative arterial saturation (71.7% +/- 16.5%) was significantly increased to 83% +/- 17.9% immediately after the procedure (p=0.017). The overall hospital mortality rate was 2.9% (16/546), with rates of 2.3% (3/128) for the classical, and 3.1% (13/418) for the modified shunts (p=not significant). The rate was significantly higher, however, for classical shunts when the pulmonary arterial diameter was less than 4 mm (15.4% versus zero; p=0.047), though this relationship was reversed for modified shunts (zero versus 3.6%; p=0.338). Early mortality was significantly influenced by the age at surgery, 5/78 (6.4%) in patients aged below 1 week, 3.7% between 1 week and 1 year, and 0.5% over 1 year (p=0.019). Early mortality was also significantly increased in patients weighing 3kg or less, 8/156 (5.1%), versus 3/303 (1.0%), p=0.037. Overall, 51 shunts failed (9.3%), 10 early and 41 late. Early failure was significantly increased in patients weighing 3kg or less, 8/156 (5.1%) versus 3/303 (1.0%), p=0.016. The overall early failure rate was 1.4% (3/215) when heparin was administered intra-operatively and for 48 hours postoperatively, in contrast to an early failure rate of 3.4% (7/203) when heparin was not used (p=0.294). Overall rates of failure during follow-up were 9.1% (17/188) in heparinized patients versus 13.6% (24/177), (p=0.173) in non-heparinized patients. Failure of classical shunts was 10.2% (13/128), compared with 6.7% (28/418) for modified shunts (p=0.195). Failure was more common overall if the pulmonary arterial diameter was less than 4 mm, 14.7% (9/61), as opposed to 8.7% (26/300) when the diameter was 4 mm or greater, (p=0.144). Administration of aspirin during follow-up after the modified shunt procedure reduced failure from 11% (18/163) to 6.7% (10/150), p=0.176. Classical or modified Blalock-Taussig shunts, either on the same side or opposite to the aortic arch, can be performed on patients of any age with minimum postoperative complications and low operative mortality. The use of intra- and post-operative heparin appears to reduce the overall rate of failure, and the administration of aspirin during follow-up appears to reduce failure of modified Blalock-Taussig shunts.
1983年至1995年间，对472例患者实施了546次布莱洛克 - 陶西格分流术：128例（23.0%）为经典分流术，其中90例与主动脉弓同侧；418例（77.0%）为改良分流术，其中182例与主动脉弓同侧。手术时，78例患者年龄小于1周，270例年龄在1周至12个月之间，198例患者年龄超过1岁。术前平均动脉血氧饱和度（71.7%±16.5%）在手术后立即显著提高至83%±17.9%（p = 0.017）。总体医院死亡率为2.9%（16/546），经典分流术的死亡率为2.3%（3/128），改良分流术的死亡率为3.1%（13/418）（p = 无显著差异）。然而，当肺动脉直径小于4mm时，经典分流术的死亡率显著更高（15.4%对零；p = 0.047），尽管这种关系在改良分流术中相反（零对3.6%；p = 0.338）。早期死亡率受手术时年龄的显著影响，1周龄以下患者为5/78（6.4%），1周龄至1岁之间为3.7%，1岁以上为0.5%（p = 0.019）。体重3kg或以下的患者早期死亡率也显著增加，为8/156（5.1%），而体重超过3kg的患者为3/303（1.0%），p = 0.037。总体而言，51次分流失败（9.3%），其中10次早期失败，41次晚期失败。体重3kg或以下的患者早期失败率显著增加，为8/156（5.1%），而体重超过3kg的患者为3/303（1.0%），p = 0.016。术中及术后48小时给予肝素时，总体早期失败率为1.4%（3/215），而未使用肝素时早期失败率为3.4%（7/203）（p = 0.294）。随访期间，肝素化患者的失败率为9.1%（17/188），非肝素化患者为13.6%（24/177）（p = 0.173）。经典分流术的失败率为10.2%（13/128），改良分流术为6.7%（28/418）（p = 0.195）。总体而言，如果肺动脉直径小于4mm，失败更常见，为14.7%（9/61），而直径为4mm或更大时为8.7%（26/300）（p = 0.144）。改良分流术后随访期间给予阿司匹林可使失败率从11%（18/163）降至6.7%（10/150），p = 0.176。经典或改良的布莱洛克 - 陶西格分流术，无论与主动脉弓同侧或异侧，均可对任何年龄的患者进行，术后并发症最少，手术死亡率低。术中及术后使用肝素似乎可降低总体失败率，随访期间给予阿司匹林似乎可降低改良布莱洛克 - 陶西格分流术的失败率。
