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

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

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: Retrograde aortic arch malperfusion after ductal stenting can be life-threatening after univentricular hybrid palliation. Arch perfusion can be maintained with a main pulmonary artery to innominate artery shunt placed during the stage I procedure: a "reverse Blalock-Taussig shunt." Methods: A retrospective review of 37 infants who underwent hybrid palliation from January 2004 to March 2010 was performed. The infants were divided into 2 groups, those with (group I, n = 16) and those without (group II, n = 21) a reverse Blalock-Taussig shunt. Results: At the initial palliation, no differences were found in the demographics, systolic or diastolic pressures, or ventricular or atrioventricular valve function between the 2 groups. Group I had more infants with aortic atresia (P <.01) and smaller ascending aortas (P <.01). Before stage II, the retrograde aortic Doppler flow velocity increased in group I (P <.01) and was unchanged in group II. The reintervention rates before stage II were similar between the 2 groups. Before stage II, the ventricular end-diastolic pressure, left and right pulmonary artery pressures and diameters, and mixed venous and arterial saturations were similar between the 2 groups. The complication rates between the 2 groups were not significantly different, although a nonsignificant trend toward more neurologic complications was noted in group I. The Kaplan-Meier survival estimate at 1 year was similar between the 2 groups (63% for group I vs 71% for group II). Conclusions: The presence of a reverse Blalock-Taussig shunt was not associated with more adverse events than those without. Gradual retrograde arch obstruction occurs commonly in palliated infants with aortic atresia. A reverse Blalock-Taussig shunt might play an important role to address the potential of retrograde obstruction, augmenting arch blood flow.

Original languageEnglish
Pages (from-to)352-357
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume146
Issue number2
DOIs
Publication statusPublished - Aug 1 2013
Externally publishedYes

Keywords

  • AVVR
  • BT
  • Blalock-Taussig
  • ECMO
  • PA
  • PVR
  • atrioventricular valve regurgitation
  • extracorporeal membrane oxygenation
  • pulmonary artery
  • pulmonary valve regurgitation
  • revBT
  • reverse BT

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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