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.