Abstract 18337: Outcomes after Intravascular Stenting for Baffle Obstruction in Patients with Transposition of the Great Arteries after Atrial Switch
Introduction: Venous baffle obstruction is a challenging complication after atrial switch operation (Mustard/Senning) for complete transposition of the great arteries (TGA). Treatment options include intravascular stenting or surgical revision, but data are limited about the benefit of one approach over the other. We report our experience with intravascular stent placement for baffle obstruction after atrial switch operation.
Methods: We reviewed clinical and hemodynamic data in pts with TGA after atrial switch who underwent cardiac catheterization from 1994-2013 at Mayo Clinic.
Results: 53 pts underwent catheterization for evaluation of possible baffle obstruction (see Table). Intravascular stenting was performed in 20 pts, 6 of whom had multiple areas of obstruction. In 5 pts with pulmonary venous baffle obstruction, stent placement was facilitated by transseptal puncture in 3 pts and a hybrid surgical-interventional approach in 2 pts. Of the 20 pts who had stenting performed, two pts developed mild recurrent stenosis of the SVC baffle at follow-up which did not require re-dilation; no patients developed baffle leak, and 19/20 pts (95%) had improvement in NYHA class (P = 0.0001); 5-year survival was 100% and freedom from baffle re-operation was 94%. Of the 22 pts who did not undergo stent placement, 7 pts had surgical baffle revision, 5 pts underwent balloon dilatation, 10 pts had no intervention, and 4 died (3 after surgery & 1 pt who had no intervention.)
Conclusion: This study is the largest reported experience of intravascular stenting for pts with TGA after atrial switch. It is an effective alternative strategy to surgery for relief of baffle obstruction and can be simultaneously employed in the both systemic baffles, and in the PV baffles via transeptal puncture or hybrid approach. After baffle stenting, we observed significant improvement in baffle obstruction gradients and improvement in NYHA class with excellent survival and freedom from re-operation.
- Adult congenital heart disease
- Congenital heart disease
- Interventional cardiology
- Pediatric cardiology
Author Disclosures: J.T. Poterucha: None. N.W. Taggart: None. A.K. Cabalka: None. D.J. Hagler: None. H.V. Schaff: None. J.A. Dearani: None. C.A. Warnes: None. F. Cetta: None.
- © 2014 by American Heart Association, Inc.