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Blalock–Taussig Shunt Size: Should it be Based on Body Weight or Target Branch Pulmonary Artery Size?

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Abstract

The study aimed to revisit the in-hospital predictors of shunt thrombosis (ST) in the foreground of the pulmonary artery size in patients who received modified Blalock–Taussig shunt (mBTS) as the first-stage palliation. Data from 80 patients who received mBTS as their initial palliative procedure between February 2012 and January 2017 was retrospectively collected. The median age and weight of the patients at the time of their mBTS procedure was 4 days (IQR 2–22 days) and 3.2 kg (IQR 2.8–3.7 kg), respectively. Of the 80 patients in the study, 11 (13.8%) developed ST. The diameter and corresponding z scores of the pulmonary arteries were significantly lower in patients with ST. The median shunt size/shunted pulmonary artery size (S/PA) ratio was considerably higher in patients with ST. In logistic regression analysis, pulmonary artery hypoplasia (PAH) [odds ratio (OR) = 13.7 (0.06–0.21), p < 0.001], S/PA ratio ≥ 0.9 [OR = 8.1 (0.03–0.53), p = 0.03], prematurity [OR = 9.5 (0.05–0.33), p = 0.003], and shunt size/weight (S/W) ratio ≥ 1.3 [OR = 6.4 (0.04–0.67), p = 0.012] were found to have a significant impact on ST. The best combination of sensitivity and specificity of the S/W (0.73 and 0.75) and the S/PA ratio (0.73 and 0.80) were achieved at the cut-off value of 1.3 and 0.9, respectively. The Youden index of S/PA was 0.52. While the area under the curve (AUC) of the S/W ratio was 0.686 ± 0.12 (p = 0.049), the AUC of the S/PA ratio was 0.791 ± 0.08 (p = 0.002). In conclusion, instead of weight, considering the size of the target pulmonary artery and thereby, the S/PA ratio would be more instructive in determining shunt size. There were a high number of patients in our study who showed PAH having received a shunt size based on their body weight. By contrast, our results showed that the S/PA ratio of ≥ 0.9 would be a good predictor of in-hospital ST.

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Authors and Affiliations

  1. Departments of Pediatric Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey

    Emrah Şişli, Osman Nuri Tuncer, Mehmet Fatih Ayık & Yüksel Atay

  2. Cardiovascular Surgery, Ege University Faculty of Medicine, Izmir, Turkey

    Suat Şenkaya

  3. Pediatric Cardiology, Ege University Faculty of Medicine, Izmir, Turkey

    Eser Doğan

  4. Medical Education, Ege University Faculty of Medicine, Izmir, Turkey

    Hatice Şahin

  5. Section of Pediatric Cardiovascular Surgery, Department of Cardiovasular Surgery, Ege University Faculty of Medicine, Kazım Dirik District, Üniversite Street, 35140, Bornova, Izmir, Turkey

    Emrah Şişli

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  1. Emrah Şişli
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  2. Osman Nuri Tuncer
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Correspondence to Emrah Şişli.

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The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Ethical Approval

The study was in accordance with the ethical standard of the institutional research committee and with the World Medical Association Declaration of Helsinki – Ethical Principles for Medical Research involving Human Subjects, adopted in 1964 and its later amendments; or with comparable ethical standards.

Additional information

The original version of this article was revised: The alignment error in Table 1 has been corrected.

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Şişli, E., Tuncer, O.N., Şenkaya, S. et al. Blalock–Taussig Shunt Size: Should it be Based on Body Weight or Target Branch Pulmonary Artery Size?. Pediatr Cardiol 40, 38–44 (2019). https://doi.org/10.1007/s00246-018-1958-9

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  • DOI: https://doi.org/10.1007/s00246-018-1958-9

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