I read with great interest the recent systematic review and meta-analysis by Ikhwani et al.[1] The authors have undertaken a valuable effort to consolidate data regarding complications and outcomes associated with the modified Blalock- Taussig-Thomas (mBT) shunt, a procedure that has played a crucial role in the palliative management of cyanotic congenital heart diseases for decades.

Nonetheless, it is of utmost importance to contextualize these findings within the current trends in congenital heart surgery. The complications highlighted in the article, namely, early shunt thrombosis, distortion of pulmonary arteries, and shunt overcirculation, phrenic nerve palsy, continue to pose significant risks, particularly in neonates and infants. These complications often necessitate urgent reintervention and are associated with increased perioperative mortality.[2,3]

In recent years, there has been a decisive shift in surgical strategy favoring early total correction over staged palliation in many cyanotic congenital cardiac lesions. Advances in neonatal anesthesia, cardiopulmonary bypass techniques, and perioperative care have allowed for primary biventricular or univentricular repair in infancy, thereby eliminating the need for interim shunt placement in a growing number of cases. This evolution reflects a broader trend away from reliance on mBT shunts, which are increasingly viewed as a historical bridge rather than a current standard.[4,5]

Ikhwani et al.'s[1] findings, while valuable, may underscore the limited contemporary role of the mBT shunt, which is now predominantly reserved for highly selected cases where early correction is not feasible. As such, this procedure may soon be considered obsolete in routine congenital cardiac surgery.

Data Sharing Statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.

Conflict of Interest: The author declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding: The author received no financial support for the research and/or authorship of this article.

References

1) Ikhwani AD, Rayhan A, Wardoyo S. Modified Blalock- Taussig-Thomas shunt blockage and mortality: A systematic review and meta-analysis. Turk Gogus Kalp Dama 2025;33:587- 587. doi: 10.5606/tgkdc.dergisi.2025.26521.

2) Petrucci O, O'Brien SM, Jacobs ML, Jacobs JP, Manning PB, Eghtesady P. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Ann Thorac Surg 2011;92:642-51. doi: 10.1016/j.athoracsur.2011.02.030.

3) Al-Ebrahim KE, Elassal AA, Eldib OS, Abdalla AHA, Allam ARA, Al-Ebrahim EK, et al. Diaphragmatic palsy after cardiac surgery in adult and pediatric patients. Asian Cardiovasc Thorac Ann 2019;27:481-5. doi: 10.1177/0218492319859806.

4) Anderson BR, Caceres M, Torres A. Contemporary outcomes of neonatal cardiac surgery: A comparison between palliative and corrective procedures. J Thorac Cardiovasc Surg 2018;155:2145-53.

5) Al-Ebrahim EK, Madani TA, Al-Ebrahim KE. Future of cardiac surgery, introducing the interventional surgeon. J Card Surg 2022;37:88-92. doi: 10.1111/jocs.16061.