Surgical approaches to the blalock shunt: does the approach matter?
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. Forty-five modified BT shunts in 41 patients, mean age 93 days...
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| Veröffentlicht in: | Heart, lung & circulation lung & circulation, 2010-08, Vol.19 (8), p.460-464 |
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| creator | Shauq, Arjamand Agarwal, Vijay Karunaratne, Ajith Gladman, Gordon Pozzi, Marco Kaarne, Markku Ladusans, Edmund J |
| description | 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.
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.
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 |
| doi_str_mv | 10.1016/j.hlc.2010.02.025 |
| format | Article |
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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.
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).
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.</description><identifier>EISSN: 1444-2892</identifier><identifier>DOI: 10.1016/j.hlc.2010.02.025</identifier><identifier>PMID: 20434951</identifier><language>eng</language><publisher>Australia</publisher><subject>Cardiac Surgical Procedures - methods ; Cardiac Surgical Procedures - statistics & numerical data ; Child, Preschool ; Female ; Heart Defects, Congenital - surgery ; Humans ; Infant ; Infant, Newborn ; Intensive Care Units - statistics & numerical data ; Length of Stay - statistics & numerical data ; Logistic Models ; Male ; Multivariate Analysis ; Oxygen Consumption ; Postoperative Period ; Retrospective Studies ; Sternotomy - methods ; Thoracotomy - methods ; Time Factors</subject><ispartof>Heart, lung & circulation, 2010-08, Vol.19 (8), p.460-464</ispartof><rights>Copyright (c) 2010 Australasian Society of Cardiac and Thoracic Surgeons and the Cardiac Society of Australia and New Zealand. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20434951$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Shauq, Arjamand</creatorcontrib><creatorcontrib>Agarwal, Vijay</creatorcontrib><creatorcontrib>Karunaratne, Ajith</creatorcontrib><creatorcontrib>Gladman, Gordon</creatorcontrib><creatorcontrib>Pozzi, Marco</creatorcontrib><creatorcontrib>Kaarne, Markku</creatorcontrib><creatorcontrib>Ladusans, Edmund J</creatorcontrib><title>Surgical approaches to the blalock shunt: does the approach matter?</title><title>Heart, lung & circulation</title><addtitle>Heart Lung Circ</addtitle><description>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.
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.
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).
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.</description><subject>Cardiac Surgical Procedures - methods</subject><subject>Cardiac Surgical Procedures - statistics & numerical data</subject><subject>Child, Preschool</subject><subject>Female</subject><subject>Heart Defects, Congenital - surgery</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Oxygen Consumption</subject><subject>Postoperative Period</subject><subject>Retrospective Studies</subject><subject>Sternotomy - methods</subject><subject>Thoracotomy - methods</subject><subject>Time Factors</subject><issn>1444-2892</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1j0tLxDAUhYMgzjj6A9xIdq5a82xaNyLD-IABF-q6JOmN7ZhOa5Mu_PdGnIELh3vvxzkchK4oySmhxe0ub73NGUk7YWnkCVpSIUTGyoot0HkIO0KoErw6QwtGBBeVpEu0fpunz85qj_U4ToO2LQQcBxxbwMZrP9gvHNp5H-9wM_y90v1I4l7HCNP9BTp12ge4POgKfTxu3tfP2fb16WX9sM1GRknMNDADhW00V6UzpFROKqLKhkLhjBFKFhIKmbo4WlJgxAnruElMUVmuGsdX6ObfN8V_zxBi3XfBgvd6D8McasW5rMpkkMjrAzmbHpp6nLpeTz_1sTf_BapfWIo</recordid><startdate>201008</startdate><enddate>201008</enddate><creator>Shauq, Arjamand</creator><creator>Agarwal, Vijay</creator><creator>Karunaratne, Ajith</creator><creator>Gladman, Gordon</creator><creator>Pozzi, Marco</creator><creator>Kaarne, Markku</creator><creator>Ladusans, Edmund J</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201008</creationdate><title>Surgical approaches to the blalock shunt: does the approach matter?</title><author>Shauq, Arjamand ; Agarwal, Vijay ; Karunaratne, Ajith ; Gladman, Gordon ; Pozzi, Marco ; Kaarne, Markku ; Ladusans, Edmund J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p210t-ae2be6cda378fb087f57078d1e6fbb47565e65016f181e20f4cf3b57069c37df3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Cardiac Surgical Procedures - methods</topic><topic>Cardiac Surgical Procedures - statistics & numerical data</topic><topic>Child, Preschool</topic><topic>Female</topic><topic>Heart Defects, Congenital - surgery</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Oxygen Consumption</topic><topic>Postoperative Period</topic><topic>Retrospective Studies</topic><topic>Sternotomy - methods</topic><topic>Thoracotomy - methods</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Shauq, Arjamand</creatorcontrib><creatorcontrib>Agarwal, Vijay</creatorcontrib><creatorcontrib>Karunaratne, Ajith</creatorcontrib><creatorcontrib>Gladman, Gordon</creatorcontrib><creatorcontrib>Pozzi, Marco</creatorcontrib><creatorcontrib>Kaarne, Markku</creatorcontrib><creatorcontrib>Ladusans, Edmund J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>Heart, lung & circulation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Shauq, Arjamand</au><au>Agarwal, Vijay</au><au>Karunaratne, Ajith</au><au>Gladman, Gordon</au><au>Pozzi, Marco</au><au>Kaarne, Markku</au><au>Ladusans, Edmund J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical approaches to the blalock shunt: does the approach matter?</atitle><jtitle>Heart, lung & circulation</jtitle><addtitle>Heart Lung Circ</addtitle><date>2010-08</date><risdate>2010</risdate><volume>19</volume><issue>8</issue><spage>460</spage><epage>464</epage><pages>460-464</pages><eissn>1444-2892</eissn><abstract>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.
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.
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).
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.</abstract><cop>Australia</cop><pmid>20434951</pmid><doi>10.1016/j.hlc.2010.02.025</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; ScienceDirect Journals (5 years ago - present) |
| subjects | Cardiac Surgical Procedures - methods Cardiac Surgical Procedures - statistics & numerical data Child, Preschool Female Heart Defects, Congenital - surgery Humans Infant Infant, Newborn Intensive Care Units - statistics & numerical data Length of Stay - statistics & numerical data Logistic Models Male Multivariate Analysis Oxygen Consumption Postoperative Period Retrospective Studies Sternotomy - methods Thoracotomy - methods Time Factors |
| title | Surgical approaches to the blalock shunt: does the approach matter? |
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