Abstract 2634: Arterial Switch after left Ventricular Retraining for late Transposition of the Great Arteries: Experience with Conventional versus Adaptable Pulmonary Artery Banding
Introduction: In late diagnosis of transposition of the great arteries (TGA) the left ventricle (LV) as it pumps against low resistance. Surgical options are atrial switch operation or retraining of the LV for an arterial switch. We apply the second procedure and report our results with different techniques since 1998.
Methods: Eleven pts underwent retraining of the LV, 7 pts (1998 –2001) had a traditional pulmonary artery band (PAB) placed ( group 1) with additional creation of an ASD (4), aortopulmonary shunt placement (3) and coarctation repair (1). Four pts had a telemetrically adaptable PAB placed without associated procedures (group 2).
Results : The results are summarized in the table⇓.
Goup 1 showed an initial mean cross banding gradient of 47mmHg, which increased to 69 mmHg at the time of the switch. Re-operations were required in 4/7, 2 of these had 1 re-op ( tightening of the PAB, partial closure of a shunt) and 2 had 2 re-ops ( opening or tightening of the PAB, coarctation repair). Two pts died, 1 of multiorgan failure after initial palliation and 1 after switch. Group 2 showed an initial cross banding gradient of 25 mmHg at 5% closing of the PAB. Incremental closure of the PAB, guided by echocardiographic parameters led to a mean gradient of 59 mmHg at the time of the switch. None of these patients required re-interventions and there were no deaths. After release of the band clip the PA unfolded and could be switched without repair.
Conclusions: Retraining of the LV by conventional PAB depends predominantly on the adequacy of PAB tightening and associated procedures required to equilibrate pulmonary and systemic output. The initial experience with telemetrically adaptable PAB is promising, it allows precise control of the tightening process, avoids repetitive surgery and minimises morbidity