Perioperative Challenges in Modified Blalock–Taussig Shunt in Neonates: A Single-center Experience

Objectives: The modified Blalock–Taussig Shunt (MBTS) is a common palliative surgery for neonates, infants, and children with congenital cyanotic heart diseases, namely tetralogy of Fallots’, pulmonary atresia to complex single ventricle heart anomalies. The MBTS procedure allows growth of the pulmonary arteries and maintains regulated blood flow to the lungs till a proper age and body weight suitable for definite corrective repair is reached. However, perioperative management, especially in neonates, remains challenging due to their unique physiology and comorbidities, in addition to the disease itself. Material and Methods: In this retrospective study, medical records of all neonates who underwent MBTS in our institute from August 2016 to May 2018 were reviewed, and 14 neonates who satisfied the inclusion criteria were included in the study. The relevant data of these neonates were collected and analyzed. Results: Preoperatively, 5 (35.71%) neonates were on prostaglandin E1 infusion. Two (14.2%) neonates had an intraoperative hypercyanotic spell and hemodynamic instability during isolation of the pulmonary vessels. Pre-operative arterial oxygen tension (PaO2) ranged from 20 to 65 mmHg and increased to 62–88 mmHg ( P = 0.0001) postoperatively. Early graft thrombosis occurred in one case (7.14%), requiring reoperation. High pulmonary blood flow (1 case [7.14%]), re-intubation (1 case [7.14%]), tracheostomy (1 case [7.14%]), and high post-operative lactate (2 cases [14.28%]) lead to altered hemodynamics, respiratory complications, and prolong intensive care unit stay. Mortality occurred in two (14.28%) cases in our series. Conclusion: The MBTS in neonates gives excellent results, but poses challenges for the team of anesthesiologists due to associated comorbidities, intrinsic neonatal physiology, apart from the lesion itself. Expert care by multidisciplinary team members, including anesthesiologists, surgeons, cardiologists, and neonatologists, and with vigilant monitoring, plays a vital role in facilitating optimal outcomes of these neonates.