Blalock Taussig Shunt

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Balram Airan - One of the best experts on this subject based on the ideXlab platform.

  • Is sternotomy superior to thoracotomy for modified Blalock–Taussig Shunt?
    Interactive Cardiovascular and Thoracic Surgery, 2013
    Co-Authors: Sachin Talwar, Manikala Vinod Kumar, Subramanian Muthukkumaran, Balram Airan
    Abstract:

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is sternotomy approach superior to a thoracotomy approach for a modified Blalock-Taussig Shunt procedure? More than 58 papers were found using the search as described below, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Three of seven papers compared the sternotomy and thoracotomy approaches. The operative approach was a significant predictor of Shunt failure. The criterion used to define early Shunt failure was either the complete occlusion during hospitalization or the need to return to the operating room for a second Shunt. The studies that compared the thoracotomy and sternotomy approaches observed increased Shunt failure rates in the thoracotomy group. The sternotomy approach was associated with advantages like less pulmonary artery distortion, ease of technical performance, cosmetic advantage of a single sternotomy incision, ease of ligation of patent ductus, less phrenic nerve injury, less collateral formation in chest wall adhesions and less thoracotomy induced scoliosis. However, other papers studied either the sternotomy approach only or the thoracotomy approach and drew conclusions regarding risk factors for operative morbidity and mortality. We conclude that the sternotomy approach is beneficial to neonates and infants undergoing modified Blalock-Taussig Shunt when compared with the conventional thoracotomy approach.

  • Homograft saphenous vein versus polytetrafluoroethylene graft for modified Blalock -Taussig Shunt
    Indian Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Arvind Kumar Bishnoi, Sachin Talwar, Shiv Kumar Choudhary, Anita Saxena, Shyam S Kothari, Rajnish Juneja, Milind Hote, V Devagourou, Balram Airan
    Abstract:

    Back ground Modified Blalock-Taussig Shunt is an important initial palliation in a selected subset of patients. This randomized controlled study was conducted to evaluate and compare PTFE and homograft saphenous vein as a conduit for this purpose.

  • Homograft saphenous vein versus polytetrafluoroethylene graft for modified Blalock -Taussig Shunt
    Indian Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Arvind Kumar Bishnoi, Sachin Talwar, Shiv Kumar Choudhary, Anita Saxena, Rajnish Juneja, Milind Hote, V Devagourou, Shyam Sunder Kothari, Balram Airan
    Abstract:

    Back ground Modified Blalock-Taussig Shunt is an important initial palliation in a selected subset of patients. This randomized controlled study was conducted to evaluate and compare PTFE and homograft saphenous vein as a conduit for this purpose. Patients and Methods Thirty patients were prospectively randomized to receive either a Polytetrafluoroethylene (PTFE) or an antibiotic preserved homograft saphenous vein as conduit. Early results were analysed and compared. Results Mean graft size was 3.93 mm±0.53 and 4.2 mm±0.53 in the PTFE and vein group respectively. There were 3 hospital deaths in the vein group and none in the PTFE group. There were 2 early and no late Shunt thromboses in PTFE group while 1 early and 2 late thrombosis occurred in vein group. These differences were statistically insignificant. The incidence of post-operative bleeding, peri-graft seroma and operative time was less in vein then PTFE group. Palliation on follow-up was comparable in both groups. Conclusion This study failed to demonstrate any benefit of homograft saphenous vein over PTFE graft in terms of thrombotic complications and mortality. There was however less bleeding and peri-graft seroma formation in the Saphenous vein (SVG) group. Further studies with greater number of patients and longer follow-up are required to demonstrate the superiority of either of these conduits.

  • modified Blalock Taussig Shunt in neonates determinants of immediate outcome
    Asian Cardiovascular and Thoracic Annals, 2000
    Co-Authors: Anil Bhan, Sachin Talwar, Rajesh Sharma, Shiv Kumar Choudhary, Balram Airan, Anita Saxena, Shyam S Kothari, Rajnish Juneja, Panangipalli Venugopal
    Abstract:

    Forty-six neonates with various conditions of low pulmonary blood flow received a modified Blalock-Taussig Shunt with a polytetrafluoroethylene graft. Ages ranged from 2 to 30 days (mean, 14.1 days). Hospital mortality was 10.9%. Shunt block requiring reoperation occurred in 3 patients. Incremental risk factors for early mortality were found to be restrictive atrial septal defect, univentricular physiology, and postoperative reintervention. It was found that a Blalock-Taussig Shunt could be performed in the neonatal period with a predictable outcome. Single-ventricle physiology and restrictive atrial septal defect were the major determinants of outcome in this subgroup.

Jay F Fricker - One of the best experts on this subject based on the ideXlab platform.

Arvind Kumar Bishnoi - One of the best experts on this subject based on the ideXlab platform.

  • Homograft saphenous vein versus polytetrafluoroethylene graft for modified Blalock -Taussig Shunt
    Indian Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Arvind Kumar Bishnoi, Sachin Talwar, Shiv Kumar Choudhary, Anita Saxena, Shyam S Kothari, Rajnish Juneja, Milind Hote, V Devagourou, Balram Airan
    Abstract:

    Back ground Modified Blalock-Taussig Shunt is an important initial palliation in a selected subset of patients. This randomized controlled study was conducted to evaluate and compare PTFE and homograft saphenous vein as a conduit for this purpose.

  • Homograft saphenous vein versus polytetrafluoroethylene graft for modified Blalock -Taussig Shunt
    Indian Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Arvind Kumar Bishnoi, Sachin Talwar, Shiv Kumar Choudhary, Anita Saxena, Rajnish Juneja, Milind Hote, V Devagourou, Shyam Sunder Kothari, Balram Airan
    Abstract:

    Back ground Modified Blalock-Taussig Shunt is an important initial palliation in a selected subset of patients. This randomized controlled study was conducted to evaluate and compare PTFE and homograft saphenous vein as a conduit for this purpose. Patients and Methods Thirty patients were prospectively randomized to receive either a Polytetrafluoroethylene (PTFE) or an antibiotic preserved homograft saphenous vein as conduit. Early results were analysed and compared. Results Mean graft size was 3.93 mm±0.53 and 4.2 mm±0.53 in the PTFE and vein group respectively. There were 3 hospital deaths in the vein group and none in the PTFE group. There were 2 early and no late Shunt thromboses in PTFE group while 1 early and 2 late thrombosis occurred in vein group. These differences were statistically insignificant. The incidence of post-operative bleeding, peri-graft seroma and operative time was less in vein then PTFE group. Palliation on follow-up was comparable in both groups. Conclusion This study failed to demonstrate any benefit of homograft saphenous vein over PTFE graft in terms of thrombotic complications and mortality. There was however less bleeding and peri-graft seroma formation in the Saphenous vein (SVG) group. Further studies with greater number of patients and longer follow-up are required to demonstrate the superiority of either of these conduits.

Mark H Hoyer - One of the best experts on this subject based on the ideXlab platform.

Sachin Talwar - One of the best experts on this subject based on the ideXlab platform.

  • modified Blalock Taussig Shunt comparison between neonates infants and older children
    Annals of Cardiac Anaesthesia, 2014
    Co-Authors: Sarvesh Pal Singh, Sachin Talwar, Milind Hote, Sandeep Chauhan, Minati Choudhury, Vishwas Malik, V Devagourou
    Abstract:

    Objective: The aim was to compare various pre-and post-operative parameters and to identify the predictors of mortality in neonates, infants, and older children undergoing Modified Blalock Taussig Shunt (MBTS). Materials and Methods: Medical records of 134 children who underwent MBTS over a period of 2 years through thoracotomy were reviewed. Children were divided into three groups-neonates, infants, and older children. For analysis, various pre-and post-operative variables were recorded, including complications and mortality. Results: The increase in PaO 2 and SaO 2 levels after surgery was similar and statistically significant in all the three groups. The requirement of adrenaline, duration of ventilation and mortality was significantly higher in neonates. The overall mortality and infant mortality was 4.5% and 8%, respectively. Conclusion: Neonates are at increased risk of complications and mortality compared with older children. Age ( 6 ml/kg, mechanical ventilation >24 h and post Shunt increase in PaO 2 (P Diff ) <25% of baseline PaO 2 are independent predictors of mortality in children undergoing MBTS.

  • Is sternotomy superior to thoracotomy for modified Blalock–Taussig Shunt?
    Interactive Cardiovascular and Thoracic Surgery, 2013
    Co-Authors: Sachin Talwar, Manikala Vinod Kumar, Subramanian Muthukkumaran, Balram Airan
    Abstract:

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is sternotomy approach superior to a thoracotomy approach for a modified Blalock-Taussig Shunt procedure? More than 58 papers were found using the search as described below, of which 11 papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Three of seven papers compared the sternotomy and thoracotomy approaches. The operative approach was a significant predictor of Shunt failure. The criterion used to define early Shunt failure was either the complete occlusion during hospitalization or the need to return to the operating room for a second Shunt. The studies that compared the thoracotomy and sternotomy approaches observed increased Shunt failure rates in the thoracotomy group. The sternotomy approach was associated with advantages like less pulmonary artery distortion, ease of technical performance, cosmetic advantage of a single sternotomy incision, ease of ligation of patent ductus, less phrenic nerve injury, less collateral formation in chest wall adhesions and less thoracotomy induced scoliosis. However, other papers studied either the sternotomy approach only or the thoracotomy approach and drew conclusions regarding risk factors for operative morbidity and mortality. We conclude that the sternotomy approach is beneficial to neonates and infants undergoing modified Blalock-Taussig Shunt when compared with the conventional thoracotomy approach.

  • Homograft saphenous vein versus polytetrafluoroethylene graft for modified Blalock -Taussig Shunt
    Indian Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Arvind Kumar Bishnoi, Sachin Talwar, Shiv Kumar Choudhary, Anita Saxena, Shyam S Kothari, Rajnish Juneja, Milind Hote, V Devagourou, Balram Airan
    Abstract:

    Back ground Modified Blalock-Taussig Shunt is an important initial palliation in a selected subset of patients. This randomized controlled study was conducted to evaluate and compare PTFE and homograft saphenous vein as a conduit for this purpose.

  • Homograft saphenous vein versus polytetrafluoroethylene graft for modified Blalock -Taussig Shunt
    Indian Journal of Thoracic and Cardiovascular Surgery, 2008
    Co-Authors: Arvind Kumar Bishnoi, Sachin Talwar, Shiv Kumar Choudhary, Anita Saxena, Rajnish Juneja, Milind Hote, V Devagourou, Shyam Sunder Kothari, Balram Airan
    Abstract:

    Back ground Modified Blalock-Taussig Shunt is an important initial palliation in a selected subset of patients. This randomized controlled study was conducted to evaluate and compare PTFE and homograft saphenous vein as a conduit for this purpose. Patients and Methods Thirty patients were prospectively randomized to receive either a Polytetrafluoroethylene (PTFE) or an antibiotic preserved homograft saphenous vein as conduit. Early results were analysed and compared. Results Mean graft size was 3.93 mm±0.53 and 4.2 mm±0.53 in the PTFE and vein group respectively. There were 3 hospital deaths in the vein group and none in the PTFE group. There were 2 early and no late Shunt thromboses in PTFE group while 1 early and 2 late thrombosis occurred in vein group. These differences were statistically insignificant. The incidence of post-operative bleeding, peri-graft seroma and operative time was less in vein then PTFE group. Palliation on follow-up was comparable in both groups. Conclusion This study failed to demonstrate any benefit of homograft saphenous vein over PTFE graft in terms of thrombotic complications and mortality. There was however less bleeding and peri-graft seroma formation in the Saphenous vein (SVG) group. Further studies with greater number of patients and longer follow-up are required to demonstrate the superiority of either of these conduits.

  • modified Blalock Taussig Shunt in neonates determinants of immediate outcome
    Asian Cardiovascular and Thoracic Annals, 2000
    Co-Authors: Anil Bhan, Sachin Talwar, Rajesh Sharma, Shiv Kumar Choudhary, Balram Airan, Anita Saxena, Shyam S Kothari, Rajnish Juneja, Panangipalli Venugopal
    Abstract:

    Forty-six neonates with various conditions of low pulmonary blood flow received a modified Blalock-Taussig Shunt with a polytetrafluoroethylene graft. Ages ranged from 2 to 30 days (mean, 14.1 days). Hospital mortality was 10.9%. Shunt block requiring reoperation occurred in 3 patients. Incremental risk factors for early mortality were found to be restrictive atrial septal defect, univentricular physiology, and postoperative reintervention. It was found that a Blalock-Taussig Shunt could be performed in the neonatal period with a predictable outcome. Single-ventricle physiology and restrictive atrial septal defect were the major determinants of outcome in this subgroup.

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