30-Day Mortality of Palliative Shunt Surgery for Cyanotic Congenital Heart Disease at Maharat Nakhon Ratchasima Hospital

Background: Palliative shunt surgery in pediatric patients with cyanotic conditions is complex and challenging. Corrective surgery is necessary for patients with reduced pulmonary blood oxygenation to address these abnormalities. Following surgery, patients demonstrate an improved survival rate. However, this operation has a considerable mortality compared to the survival benefit. Patients and Methods: This study is a retrospective analysis collecting data on pediatric patients with cyanotic conditions who underwent palliative shunt surgery between January 1, 2020, and January 1, 2023. The patients were categorized into 4 procedural groups: Group 1, patients who underwent the modified Blalock-Taussig-Thomas shunt; Group 2, those who received the modified Waterston shunt; Group 3, patients with the central shunt; and Group 4, those who had the modified Pott’s shunt, respectively. Results: A total of 86 pediatric patients with cyanotic congenital heart conditions underwent palliative shunt surgery, primarily closed-heart procedures. Nearly three-quarters of the patients (65 cases, 75.5%) were between 1 day and 1 year old. The modified Blalock-Taussig-Thomas shunt was the most common procedure performed in 56 patients (65.1%). Postoperative blood oxygen levels showed a statistically significant increase compared to preoperative levels in both the modified Blalock-Taussig-Thomas shunt and modified Waterston shunt procedures. Among the 56 patients who underwent the modified Blalock-Taussig-Thomas shunt, the 30-day mortality rate was 3.6%. For the modified Waterston shunt performed on 24 patients, the 30-day mortality rate was 12.5%. The Central shunt procedure was performed on 5 patients, with a 30-day mortality rate of 4 cases (80%). Overall, the 30-day mortality rate across all 86 cyanotic congenital heart disease patients undergoing palliative shunt surgery was 10.5%. Conclusion: Four palliative shunt procedures are closed-heart surgeries intended as interim measures before major corrective surgery to address intracardiac abnormalities. Following the corrective surgeries, postoperative blood oxygen levels were higher than preoperative levels.