“Reverse Blalock-Taussig shunt”: Application in single ventricle hybrid palliation

Baba, Kenji; Honjo, Osami; Chaturvedi, Rajiv; Lee, Kyong Jin; Arsdell, Glen Van; Caldarone, Christopher A.; Benson, Lee

doi:10.1016/j.jtcvs.2012.11.029

Cited by 33 publications

(16 citation statements)

References 17 publications

(19 reference statements)

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“…3,9–11 Caldarone and colleagues, from the Hospital for Sick Children in Toronto, described the potential for retrograde aortic arch obstruction after ductal stent deployment, 9,19 and this group now routinely uses a reverse Blalock–Taussig shunt in patients with aortic atresia or severely restricted antegrade aortic blood flow. 9,21 In addition, the timing of left atrial decompression and whether stent placement is used routinely after septostomy are modifiable procedural factors that are variably used at different centers. 3,4,9,10 …”

Section: Discussionmentioning

confidence: 99%

Stage 1 hybrid palliation for hypoplastic left heart syndrome—assessment of contemporary patterns of use: An analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Karamlou

Overman

Hill

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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Objective Hybrid palliation is an alternative to Norwood stage 1 for the initial management of hypoplastic left heart syndrome. Contemporary multicenter hybrid use and institutional/patient factors associated with hybrid use relative to the Norwood have not been evaluated. We describe hybrid use in relation to institutional volume, patient factors, and short-term outcomes. Methods Infants aged 60 days or less listed in The Society of Thoracic Surgeons Congenital Heart Surgery Database (2010–2012) undergoing initial palliation of hypoplastic left heart syndrome were included. Annual institutional hybrid use rates were calculated: [hybrid procedures/(Norwood + hybrid + transplant procedures)]. In-hospital outcomes for primary hybrid and primary Norwood were compared and stratified by high (defined as ≥50%) versus low (defined as ≤10%) institutional hybrid use. Results Of 1728 patients (100 centers), most (n = 1496, 87%) underwent an index Norwood; 232 patients (13%) underwent an index hybrid procedure. Preoperative patient risk factors were more prevalent in patients undergoing the hybrid procedure. Only 13 of 100 institutions were high hybrid users, and these tended to have lower annual hypoplastic left heart syndrome index case volume. Unadjusted in-hospital mortality was higher for the hybrid compared with the Norwood procedure (30%vs 16%; P<.001). In-hospital mortality for the hybrid procedure was not associated with hybrid use (26%among institutions with low use vs 28%among institutions with high use). However, centers with high hybrid use had higher mortality after the Norwood (43%) compared with centers with low hybrid use (16%). Conclusions Few centers currently select the hybrid procedure for most infants with hypoplastic left heart syndrome. Although unadjusted in-hospital hybrid mortality is higher than Norwood mortality, potential risk factors are more prevalent among hybrid cases. Institutions with higher hybrid use have lower hypoplastic left heart syndrome case volume and higher Norwood mortality.

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Section: Discussionmentioning

confidence: 99%

Stage 1 hybrid palliation for hypoplastic left heart syndrome—assessment of contemporary patterns of use: An analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Karamlou

Overman

Hill

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

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“…The prophylactic use of a reverse modified Blalock-Taussig shunt in patients with absent or limited antegrade aortic flow has been suggested [56], especially because retrograde obstruction is more likely to develop in patients with aortic atresia [54,57]. Its efficiency to reduce the hemodynamic effect of retrograde arch obstruction while maintaining adequate perfusion of upper and lower body has been shown in a lumped parameter model [58].…”

Section: Retrograde Aortic Arch Obstructionmentioning

confidence: 99%

The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

Haller

Caldarone

2018

The Annals of Thoracic Surgery

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“…In Sao Paulo, Brazil, the Columbus Hybrid-variant also supplanted the use of the Norwood procedure [31]. Subsequently, the group in Toronto described an additional variant of the Hybrid approach for HLHS patients with aortic atresia [32]. This approach added a reverse MBTS after bPAB placement, but prior to ductal stent placement.…”

Section: The Hybrid Approachmentioning

confidence: 99%

“…We recommend against manipulations such as transpulmonary ductal stenting or placement of a reverse MBTS, which may result in blood loss, circulatory instability, or need for inotropic infusions. Concurrent use of additional interventions at this time have been associated with reported mortality rates between 10 to 25% [32, 35]. Conversely, the surgical approach in Giessen is simply focused on bPAB, the surgical procedure mortality has been less than 1% [29].…”

Section: The Hybrid Approachmentioning

confidence: 99%

Current Therapy for Hypoplastic Left Heart Syndrome and Related Single Ventricle Lesions

2016

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Universally fatal only four decades ago, the progress in the three-stage palliation of hypoplastic left heart syndrome and related single right ventricular lesions has drastically improved the outlook for these patients. While the stage II operation (hemi-Fontan or bidirectional Glenn) and stage III Fontan procedure have evolved into relatively low risk operations, the stage I Norwood procedure remains one of the highest risk and costliest common operations performed in congenital heart surgery. Yet, despite this fact, experienced centers now report hospital survivals in excess of 90% for the Norwood. This traditional three-stage surgical palliation has seen several innovations in the past decade aimed at improving outcomes, particularly for the Norwood procedure. One significant change is a renewed interest in the right ventricle-to-pulmonary artery shunt as the source of pulmonary blood flow, rather than the modified Blalock-Taussig shunt for the Norwood. The multi-institutional Single Ventricle Reconstruction trial randomized 555 patients to one or the other shunt, and these subjects continue to be followed closely as they now approach 10 years post-randomization. In addition to modifications to the Norwood procedure, the “hybrid procedure,” a combined catheter-based and surgical approach, avoids the Norwood procedure in the newborn period entirely. The initial hybrid procedure is then followed by a “comprehensive” stage II, that combines components of both the Norwood and the traditional stage II, and later completion of the Fontan. Proponents of this approach hope to not only improve short-term survival, but potentially longer-term outcomes, such as neurodevelopment, as well. Regardless of the approach, traditional surgical staged palliation or the hybrid procedure, survivals have vastly improved, and large numbers of these patients are surviving not only through their Fontan in early childhood, but into adolescence and young adulthood. As this population grows, it becomes increasingly important to understand the longer-term outcomes of these Fontan patients, not only in terms of survival, but also burden of disease, neurodevelopmental outcomes, psychosocial development and quality of life.

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“Reverse Blalock-Taussig shunt”: Application in single ventricle hybrid palliation

Cited by 33 publications

References 17 publications

Stage 1 hybrid palliation for hypoplastic left heart syndrome—assessment of contemporary patterns of use: An analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

Stage 1 hybrid palliation for hypoplastic left heart syndrome—assessment of contemporary patterns of use: An analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

The Evolution of Therapeutic Strategies: Niche Apportionment for Hybrid Palliation

Current Therapy for Hypoplastic Left Heart Syndrome and Related Single Ventricle Lesions

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