Perioperative strategy to minimize mortality in neonatal modified Blalock-Taussig-Thomas Shunt: A literature review

The Blalock-Taussig-Thomas Shunt (BTTS) procedure was first introduced by Alfred Blalock, Hellen B. Taussig, and Vivien Thomas in 1944. The procedure is performed by making a connection between the subclavian artery to the pulmonary artery to augment pulmonary blood flow. BTTS is used to palliate neonates born with restrictive pulmonary blood flow disorders (cyanotic congenital heart disease). The modified BTTS (MBTTS) procedure is still seen as high risk and has quite high morbidity and mortality rates, especially in the neonatal group. Recent studies suggest a mortality of up to 15% in the single ventricle group and 3% in the biventricular group. Based on a literature search, several risk factors such as patient weight, shunt size/body weight ratio, underlying cardiac malformations, use of mechanical ventilator support, sternotomy approach and use of CPB machines have been shown to increase mortality. Current perioperative risk assessment methods and recommendations are also covered. In addition, our review article specifically discusses perioperative strategies including strategies for surgeons using the MBTTS procedure (surgical approach, determining shunt size and anastomosis techniques) and postoperative strategies (anticoagulation management and strategy to deal with undershunting/overshunting problems). (C) 2021 Sociedad Espan tilde ola de Cirugi acute accent a Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.

Automated summary

The Blalock-Taussig-Thomas Shunt (BTTS) procedure is a surgical technique used to improve restrictive pulmonary blood flow disorders in neonates. The procedure carries significant risk with high morbidity and mortality rates, which are influenced by factors such as patient weight, shunt size, underlying cardiac malformations, and perioperative strategies. This review article discusses the various aspects of the procedure, including surgical approaches, risk assessment, and postoperative management.