Left Ventricular Retraining and Double Switch in Patients With Congenitally Corrected Transposition of the Great Arteries

Ibrahimiye, Ali N.; Mainwaring, Richard D.; Patrick, William L.; Downey, Laura; Yarlagadda, Vamsi V.; Hanley, Frank L.

doi:10.1177/2150135116683939

Cited by 29 publications

(26 citation statements)

References 40 publications

(52 reference statements)

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“…Based on previous experience derived from re-training of the subpulmonary left ventricle before anatomical correction in congenitally corrected transposition of the great arteries (TGA) or before arterial switch for dextro-TGA (D-TGA), (22)(23)(24)(25) PAB has been applied to treat ESHF in children with DCM and preserved right ventricle function (26).…”

Section: Pulmonary Artery Banding For Myocardial Rehabilitationmentioning

confidence: 99%

Pulmonary Artery Banding for Ventricular Rehabilitation in Infants With Dilated Cardiomyopathy: Early Results in a Single-Center Experience

et al. 2020

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Background: Pulmonary artery banding (PAB) is reported as an innovative strategy for children with end-stage heart failure (ESHF) to bridge to transplantation or recovery. We report our early experience with PAB to evaluate outcomes, indications, and limitations. Materials and Methods: This is a single-center prospective clinical study, including infants and children admitted for ESHF owing to dilated cardiomyopathy (DCM) with preserved right ventricular function after failure of maximal conventional therapy. All patients underwent perioperative anticongestive medical therapy with ACE inhibitor, beta blocker, and spironolactone. Post-operatively, all patients underwent echocardiographic follow-up to assess myocardial recovery. Results: We selected five patients (four males) who underwent PAB at a median age of 8.6 months (range 3.9-42.2 months), with preoperative ejection fraction (EF) < 30%. Sternal closure was delayed in all. One patient did not improve after PAB and underwent Berlin Heart implantation after 33 days, followed by heart transplant after 13 months. Four patients were discharged home on full anticongestive therapy. However, 2 months after discharge, one patient experienced severe acute heart failure secondary to pneumonia, which required mechanical circulatory support, and the patient underwent a successful heart transplant after 21 days. The remaining three patients are doing well at home, 22.4, 16.9, and 15.4 months after PAB. They all underwent elective percutaneous de-banding, 18.5, 4.8, and 10.7 months after PAB. EF increased from 17.7 ± 8.5% to 63.3 ± 7.6% (p = 0.03), and they have all been delisted. Conclusion: Use of PAB may be an effective alternative to mechanical support in selected infants for bridging to transplant or recovery. Better results seem to occur in patients aged < 12 months. Further experience and research are required to identify responders and non-responders to this approach.

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Section: Pulmonary Artery Banding For Myocardial Rehabilitationmentioning

confidence: 99%

Pulmonary Artery Banding for Ventricular Rehabilitation in Infants With Dilated Cardiomyopathy: Early Results in a Single-Center Experience

et al. 2020

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“…Since then, numerous centers have reported favorable outcomes following anatomic repair. 12 –18 When considering the strategy of anatomic correction, the incomplete natural history data on the systemic RV in this condition confounds the decision to routinely proceed with anatomic correction (with or without LV training) at the time of diagnosis, even during childhood, particularly in the absence of signs or symptoms of RV or Tricuspid value (TV) dysfunction. For purposes of management strategy, three basic decision points might be considered at the time of presentation: No or minor associated cardiac lesions that don’t require surgical intervention with preserved RV function; Major associated cardiac lesions that merit operation with preserved RV function; The development of major RV dysfunction at any time, but without symptoms; and The development of major RV dysfunction with heart failure symptoms. …”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary artery banding and anatomic correction before two and three years of age have been recommended to allow for ventricular hyperplasia instead of hypertrophy, theoretically reducing the chances of left ventricular failure. 13,15…”

Section: Natural History and Recommendations After Rv Dysfunction Devmentioning

confidence: 99%

Congenitally Corrected Transposition Presenting in the First Year of Life: Survival and Fate of the Systemic Right Ventricle

Smood

Kirklin

Pavnica

et al. 2019

World J Pediatr Congenit Heart Surg

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Introduction: Knowledge gaps exist in the life expectancy and functional outcome of patients with congenitally corrected transposition (ccTGA) presenting early in life, which is relevant in the evaluation of early anatomic repair. Methods: In a singlecenter analysis, 91 patients with ccTGA were identified over 25 years, of which 31 presented with biventricular anatomy in the first year of life and formed the study cohort. End points for analysis included survival, moderate or worse tricuspid valve regurgitation, and systemic right ventricle (RV) dysfunction. Median follow-up was 4.9 years (range: 7 days to 20 years). Results: Among 31 patients presenting in the first year of life, 9 (29%) never received cardiac surgery, while 22 (71%) underwent 36 cardiac operations. Overall freedom from moderate or severe systemic RV dysfunction was 75% at 10 years. Overall survival was 82% at 10 years. Surgical mortality was 5.6% (2/36). Among survivors with a systemic RV, 23 (100%) of 23 were Ross or NYHA class I or II at last follow-up. Conclusions: Congenitally corrected transposition presenting in the first year of life and maintaining a systemic RV can expect (1) long-term survival of more than 80% at 10 years, (2) low expected surgical mortality (overall 6%), and (3) 75% late freedom from major RV dysfunction at 10 years. Pending multi-institutional analyses, this experience with a systemic RV in ccTGA provides an initial benchmark for comparison when considering early elective anatomic correction.

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“…Anatomic correction for ccTGA, which is known as a double switch operation, is expected to improve long-term outcomes by utilizing the mLV as a systemic pumping chamber. 1 Hraska et al reported that the survival and freedom from any event after a double switch operation were 95% and 71%, respectively, at 15-year follow-up. 2 Pulmonary artery banding is performed for mLV training before the double switch operation when the pressure of mLV is low.…”

Section: Discussionmentioning

confidence: 99%

“…An atrial–arterial switch (double switch) operation has been shown to improve patient survival. 1 A pulmonary artery banding (PAB) is performed for morphological left ventricle (mLV) training before a double switch operation when the mLV pressure is low. Pulmonary artery banding has also been reported to result in ventricular septal movement, improvement in tricuspid valve coaptation, and decrease in tricuspid valve regurgitation (TR).…”

Section: Introductionmentioning

confidence: 99%

Pulmonary Artery Banding for Congenitally Corrected Transposition of the Great Arteries With Hydrops Fetalis: A Case Report

Takeda

Momoi

Hayashi

et al. 2019

World J Pediatr Congenit Heart Surg

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At 32 weeks of gestation, a male fetus with congenitally corrected transposition of the great arteries developed hydrops fetalis caused by a combination of mitral valve regurgitation and tricuspid valve regurgitation (TR). We performed a pulmonary artery banding (PAB) at 108 days old for gradually progressing TR, after confirming that a balloon dilatation test in the main pulmonary artery reduced TR. As the patient grew, the PAB became tighter and systolic blood pressure in the morphological left ventricle increased. At present, the patient is waiting for a double switch operation.

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Left Ventricular Retraining and Double Switch in Patients With Congenitally Corrected Transposition of the Great Arteries

Cited by 29 publications

References 40 publications

Pulmonary Artery Banding for Ventricular Rehabilitation in Infants With Dilated Cardiomyopathy: Early Results in a Single-Center Experience

Pulmonary Artery Banding for Ventricular Rehabilitation in Infants With Dilated Cardiomyopathy: Early Results in a Single-Center Experience

Congenitally Corrected Transposition Presenting in the First Year of Life: Survival and Fate of the Systemic Right Ventricle

Pulmonary Artery Banding for Congenitally Corrected Transposition of the Great Arteries With Hydrops Fetalis: A Case Report

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