Surgical approaches to the blalock shunt: does the approach matter?
OBJECTIVE
The Blalock-Taussig (BT) shunt is an excellent palliative procedure for cyanotic congenital heart defects. We reviewed two techniques of performing the BT shunt, median sternotomy and thoracotomy, in relation to morbidity and mortality.


METHODS
Forty-five modified BT shunts in 41 patients, mean age 93 days (1-1045 days), were performed between January 2002 and October 2004. Twenty-four (53.3%) shunts in 21 (51.2%) patients were performed through thoracotomy and 21 (46.7%) shunts in 20 (48.8%) patients through median sternotomy. One surgeon preferred thoracotomy and the other sternotomy approach irrespective of age/weight or elective/emergency. Thirty-eight (84.4%) cases underwent elective operation and 7 (15.6%) cases were operated as emergencies. In both groups the most frequent diagnosis was complex Tetralogy of Fallot.


RESULTS
Postoperative oxygen saturation was same in both groups and there were no significant complications in either group. Patients undergoing BT shunt via median sternotomy approach had longer duration of ventilation (mean 183 h vs. 53 h, P<0.001) and inotropic requirements (33.3% vs. 4.2%, P<0.05) leading to longer intensive care unit stay (mean 9.14 days vs. 3.3 days, P<0.05) and hospital stay (mean 14.59 days vs. 5 days P<0.005).


CONCLUSIONS
Median sternotomy approach to performing BT shunt seems to carry a higher morbidity than thoracotomy. We recommend a large case series study and longer follow up.
Shauq
Arjamand
A
Department of Paediatric Cardiology, Alder Hey Royal Children Hospital, Eaton Rd, Liverpool L12 2AP, United Kingdom. shauq7@yahoo.com
Agarwal
Vijay
V
Karunaratne
Ajith
A
Gladman
Gordon
G
Pozzi
Marco
M
Kaarne
Markku
M
Ladusans
Edmund J
EJ
D006348:Cardiac Surgical Procedures / Q000379:methods* / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010101:Oxygen Consumption; D011184:Postoperative Period; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors