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The Journal of Cardiovascular Surgery 1999 February;40(1):107-10

language: English

Classic Bla­lock-­Taussig ­shunt in neo­nates

Yoshimura N., Yamaguchi M., Ohashi H., Oshima Y., Toyoda Y., Ogawa K.

From the Depart­ment of Car­di­oth­o­racic Sur­gery Kobe ­Children’s Hos­pital, ­Kobe, ­Japan


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Back­ground. The ­choice of pal­li­a­tive pro­ce­dure for neo­nates ­with con­gen­ital cya­notic ­heart ­defects ­remains con­tro­ver­sial. Sev­eral ­reports ­have ques­tioned ­whether the ­classic Bla­lock-­Taussig ­shunt is ade­quate in neo­nates, ­because it ­shows a ­high ­rate of mor­tality and ­early ­shunt ­failure. The pur­pose of ­this ­study is to eval­uate the ­early and ­late ­results of ­classic Bla­lock-­Taussig ­shunt in neo­nates.
­Methods. ­From ­December 1981 to ­December 1996, 31 neo­nates under­went a ­classic Bla­lock-­Taussig ­shunt. ­Mean age at oper­a­tion was 15.9 ­days (­range, 2 to 28 ­days), and ­mean ­body ­weight was 3214 g (­range, 2229 to 4468 g). The ­major diag­noses ­were pul­mo­nary ­atresia ­with ­intact ven­tric­ular ­septum (6 ­patients) and ­with ven­tric­ular ­septal ­defect (4), uni­ven­tric­ular ­heart (6), tri­cuspid ­atresia (5), tet­ralogy of ­Fallot (4), trans­po­si­tion of the ­great ­arteries (3), and ­double ­outlet ­right ven­tricle (3).
­Results. ­There ­were no ­early ­deaths. ­There was one ­early ­shunt ­failure. The ­patient under­went a replace­ment of Bla­lock-­Taussig ­shunt by vas­cular ­graft on the 1st post­op­er­a­tive day. Two ­patients ­with non-con­fluent cen­tral pul­mo­nary ­artery under­went a con­tra­lat­eral mod­i­fied Bla­lock-­Taussig ­shunt on the 22nd and 42nd post­op­er­a­tive ­day, respec­tively. ­There ­were two ­late ­deaths ­before the defin­i­tive ­repair was per­formed. ­Twelve ­patients ­required an addi­tional ­shunt oper­a­tion. The ­mean ­interval ­between the ­initial and the ­second ­shunt pro­ce­dure was 27.7 ­months (­range, 6 to 67 ­months). Ten ­patients under­went defin­i­tive oper­a­tion and the ­mean ­interval to ­that pro­ce­dure was 55.5 ­months (­range, 14 to 121 ­months). ­Shunt ­patency was 94.7±5.1% at 3 ­years. The ­freedom ­from car­diac ­event (car­diac ­deaths or ­repeat ­shunting pro­ce­dure) was 80.5±7.1% at 1 ­year and 54.9±9.4% at 3 ­years.
Con­clu­sions. The ­classic Bla­lock-­Taussig ­shunt has a low oper­a­tive mor­tality and has pro­vided excel­lent ­long-­term pal­li­a­tion in the neo­nate. We con­clude ­that a ­classic Bla­lock-­Taussig ­shunt ­should be con­sid­ered a rea­son­able ­choice in neo­nates ­requiring a pal­li­a­tive pro­ce­dure for con­gen­ital cya­notic ­heart ­defects.

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