{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T19:10:06Z","timestamp":1780513806965,"version":"3.54.1"},"reference-count":28,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,31]],"date-time":"2026-05-31T00:00:00Z","timestamp":1780185600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Early thrombosis of systemic-to-pulmonary artery shunts (SPS) remains a major cause of morbidity and mortality in neonates with duct-dependent pulmonary circulation. Despite advances in surgical technique, no universally accepted perioperative thrombosis-prevention protocol exists. We evaluated the early outcomes of a standardized perioperative thrombosis-prevention protocol applied in neonates undergoing SPS placement. Methods: This single-center case series included nine consecutive neonates undergoing primary modified Blalock\u2013Taussig shunt placement between January 2024 and July 2025. A predefined and standardized perioperative thrombosis-prevention protocol was uniformly applied, incorporating preoperative aspirin when feasible, intraoperative systemic heparinization targeting activated clotting time (ACT) &gt; 300 s, meticulous shunt flushing and de-airing, preferential distal anastomosis to the main pulmonary artery when anatomically suitable, and early postoperative continuous heparin infusion followed by enteral aspirin. The primary endpoint was early shunt thrombosis within 30 days. Results: Median age at surgery was 28 days (range 14\u201335), and median operative weight was 3.2 kg (range 2.8\u20133.6). Cardiopulmonary bypass was required in 33.3% of patients. Delayed sternal closure was performed in 22.2%. Despite recognized prothrombotic risk factors\u2014including complex anatomy, hypoplastic pulmonary arteries, and low cardiac output syndrome (33.3%)\u2014no early shunt thrombosis occurred (0\/9). There were no reinterventions, no early mortality, and no major bleeding or intracranial hemorrhage. Conclusions: In this single-center neonatal series, implementation of a standardized perioperative thrombosis-prevention protocol was associated with preserved early shunt patency without increased bleeding risk. Although limited by a small sample size, these findings support the feasibility and short-term safety of a standardized perioperative management strategy in neonatal systemic-to-pulmonary shunt surgery. These findings should be considered hypothesis-generating and not evidence of definitive effectiveness.<\/jats:p>","DOI":"10.3390\/children13060766","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T18:08:07Z","timestamp":1780510087000},"page":"766","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Standardized Perioperative Thrombosis Prevention in Neonatal Modified Blalock\u2013Taussig Shunt Surgery: An Algorithm-Based Single-Center Case Series"],"prefix":"10.3390","volume":"13","author":[{"given":"Valentin","family":"Stroe","sequence":"first","affiliation":[{"name":"Institution Organizing University Doctoral Studies, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"},{"name":"Emergency Institute of Cardiovascular Diseases and Transplant, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3221-4276","authenticated-orcid":false,"given":"Lacramioara Eliza","family":"Chiperi","sequence":"additional","affiliation":[{"name":"Emergency Institute of Cardiovascular Diseases and Transplant, 540136 Targu Mures, Romania"},{"name":"Pediatrics Departament, University of Medicine and Pharmacy \u201cIuliu Hatieganu\u201d, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Horatiu","family":"Suciu","sequence":"additional","affiliation":[{"name":"Emergency Institute of Cardiovascular Diseases and Transplant, 540136 Targu Mures, Romania"},{"name":"Department of Surgery IV, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9044-8866","authenticated-orcid":false,"given":"Marius","family":"Harpa","sequence":"additional","affiliation":[{"name":"Emergency Institute of Cardiovascular Diseases and Transplant, 540136 Targu Mures, Romania"},{"name":"Department of Surgery IV, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David Emanuel","family":"Anitei","sequence":"additional","affiliation":[{"name":"Institution Organizing University Doctoral Studies, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"},{"name":"Emergency Institute of Cardiovascular Diseases and Transplant, 540136 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Gozar","sequence":"additional","affiliation":[{"name":"Emergency Institute of Cardiovascular Diseases and Transplant, 540136 Targu Mures, Romania"},{"name":"Department of Surgery IV, University of Medicine, Pharmacy, Science and Technology \u201cGeorge Emil Palade\u201d, 540142 Targu Mures, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1001\/jama.1945.02860200029009","article-title":"The surgical treatment of malformations of the heart","volume":"128","author":"Blalock","year":"1945","journal-title":"JAMA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/j.athoracsur.2011.02.030","article-title":"Risk Factors for Mortality and Morbidity after the Neonatal Blalock\u2013Taussig Shunt Procedure","volume":"92","author":"Petrucci","year":"2011","journal-title":"Ann. 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