Patientsâ€™ characteristics following reoperation after Modified Blalock-Taussig Shunt (MBTS) in Cardiac Centre National General Hospital Cipto Mangunkusumo from 2018-2020

Suprayitno Wardoyo; Joshua Parsaoran Partogi Pardede; Hari Agung Asari

doi:10.15562/bmj.v10i1.2124

Patientsâ€™ characteristics following reoperation after Modified Blalock-Taussig Shunt (MBTS) in Cardiac Centre National General Hospital Cipto Mangunkusumo from 2018-2020

Suprayitno Wardoyo ,

Joshua Parsaoran Partogi Pardede ,

Hari Agung Asari ,

PDF |
DOI: https://doi.org/10.15562/bmj.v10i1.2124 |
Published: 2021-04-01

Abstract

Background: Modified Blalock-Taussig shunt (MBTS) is a common palliative procedure for congenital heart defect to connect the systemic to the pulmonary circulation via a synthetic shunt from a subclavian artery to a pulmonary artery. However, certain postoperative complications do exist, such as blockage. Early identification of modifiable risk factors is important to prompt early intervention for better outcomes.

Material: This article is a descriptive narrative retrospective study. We gather data from the Cipto Mangunkusumo Hospital Cardiovascular Center medical report of 8 patients having undergone reoperation post-MBTS surgery as their first operation between January 2018 and October 2020. Data were analyzed using SPSS version 20 for Windows.

Results: The patientâ€™s age ranged from 3 months to 30 years old. Seven of them suffered from shunt occlusion complications, while the other suffered from the bleeding problem. The laboratory results showed that preoperative hemoglobin (18.9Â±4.1 g/dL vs. 16.90 (10.80-19.20) g/dL), hematocrit (58.8Â±12.40% vs. 42.9Â±14.30%), platelet counts (284.487Â±147.003 vs. 210.625Â±104.688) 10³/uL, and oxygen saturation (86.00 (75.00-89.00) vs. 70.00Â±17.00) levels were higher than the pre-reoperative. The coagulation markers showed that PT value has increasing trend (1.10 (0.90-2.30) vs. 1.30Â±0.20) while aPTT (5.90 (2.90-6.30) vs. 2.30 (1.60-5.30)) seconds and activated clotting time (ACT) (205.00Â±86.00 vs. 165.00 (114.00-255.00)) showed the opposite.

Conclusion: MBTS remains the first-choice bridging palliation surgery to increase the pulmonary blood flow in congenital heart defects. The cause of shunt failure remains inconclusive in this study. Other studies suggest that graft material choice, S/PA ratio, S/W ratio, operative approach, thrombus formation, and aPTT value contribute to shunt failure, thus needing a reoperation.

References

Yoo BW. Epidemiology of Congenital Heart Disease with Emphasis on Sex-Related Aspects. Adv Exp Med Biol. 2018;1065:49-59.
Gedicke M, Morgan G, Parry A, Martin R, Tulloh R. Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations. Heart Vessels. 2010;25(5):405-409.
KÃ¼Ã§Ã¼k M, Ã–zdemir R, KaraÃ§elik M, DoksÃ¶z Ã–, Karadeniz C, Yozgat Y, et al. Risk Factors for Thrombosis, Overshunting and Death in Infants after Modified Blalock-Taussig Shunt. Acta Cardiol Sin. 2016;32(3):337-42.
ÅžiÅŸli E, Tuncer ON, Åženkaya S, DoÄŸan E, Åžahin H, AyÄ±k MF, et al. Blalock-Taussig Shunt Size: Should it be Based on Body Weight or Target Branch Pulmonary Artery Size? Pediatr Cardiol. 2019;40(1):38-44.
Shibata M, Itatani K, Oka N, Yoshii T, Nakamura Y, Kitamura T, et al. Optimal Graft Size of Modified Blalock-Taussig Shunt for Biventricular Circulation in Neonates and Small Infants. Int Heart J. 2015;56(5):533-6.
Kaur R, Bhurtel D, Bielefeld MR, Morales JM, Durham LA 3rd. Cryopreserved Saphenous Vein Compared With PTFE Graft for Use as Modified Blalock-Taussig or Central Shunt in Cyanotic Congenital Heart Disease. World J Pediatr Congenit Heart Surg. 2018;9(5):509-512.
Arnaz A, PiÅŸkin Åž, OÄŸuz GN, YalÃ§Ä±nbaÅŸ Y, Pekkan K, SarÄ±oÄŸlu T. Effect of modified Blalock-Taussig shunt anastomosis angle and pulmonary artery diameter on pulmonary flow. Anatol J Cardiol. 2018;20(1):2-8.
Talwar S, Kumar MV, Muthukkumaran S, Airan B. Is sternotomy superior to thoracotomy for modified Blalock-Taussig shunt?. Interact Cardiovasc Thorac Surg. 2014;18(3):371-375.
Shauq A, Agarwal V, Karunaratne A, Gladman G, Pozzi M, Kaarne M, Ladusans EJ. Surgical approaches to the blalock shunt: does the approach matter? Heart Lung Circ. 2010;19(8):460-4.
Moszura T, Zubrzycka M, Michalak KW, Rewers B, Dryzek P, Moll JJ, et al. Acute and late obstruction of a modified Blalock-Taussig shunt: a two-center experience in different catheter-based methods of treatment. Interact Cardiovasc Thorac Surg. 2010;10(5):727-31.
Loyd A, Gorodin P, Liu Z, Capozzoli N, Nahar T, Entwistle J 3rd, et al. Delineation of intracardiac shunts using contrast echocardiography. J Am Soc Echocardiogr. 2003 Jul;16(7):770-3. doi: 10.1016/S0894-7317(03)00286-4. PMID: 12835665.
Bohnen JD, Ramly EP, Sangji NF, de Moya M, Yeh DD, Lee J, et al. Perioperative risk factors impact outcomes in emergency versus nonemergency surgery differently: Time to separate our national risk-adjustment models? J Trauma Acute Care Surg. 2016;81(1):122-30.
Thorpe MH, Holinski PM, Al Aklabi M, Bauman ME, Ryerson LM. Analysis of post-operative systemic to pulmonary artery shunt failure. Annals of Cardiology and Vascular Medicine. 2018;1:1-5.
Li D, Wang Y, Lin K, An Q. Modified Blalock-Taussig Shunt: A Single-Center Experience and Follow-Up. Heart Surg Forum. 2020;23(1):E053-E057.
Ismail SR, Almazmi MM, Khokhar R, AlMadani W, Hadadi A, Hijazi O, et al. Effects of protocol-based management on the post-operative outcome after systemic to pulmonary shunt. Egypt Heart J. 2018;70(4):271-278.
Guzzetta NA, Foster GS, Mruthinti N, Kilgore PD, Miller BE, Kanter KR. In-hospital shunt occlusion in infants undergoing a modified blalock-taussig shunt. Ann Thorac Surg. 2013;96(1):176-182.