Intravascular and hybrid intraoperative stent placement for baffle obstruction in transposition of the great arteries after atrial switch

Abstract

This study is the largest reported experience of intravascular and intra-operative hybrid stent placement for patients with TGA after atrial switch. Transcatheter and minimally invasive hybrid intraoperative surgical stent placement are an effective strategy for relief of systemic and pulmonary venous baffle obstruction. © 2016 Wiley Periodicals, Inc.

Canadian Cardiovascular Society 2022 Guidelines for Cardiovascular Interventions in Adults With Congenital Heart Disease

“…Percutaneous intervention is often feasible for systemic venous baffle obstruction and successful in improving symptoms and/or facilitating nonobstructing access for transvenous pacemaker or defibrillator leads. 177,178 Leaks in the interatrial baffles are more common than clinically suspected, detectable in up to 65% of patients using echocardiography with saline contrast. 179 Transesophageal echocardiography is helpful to identify the size and location of the interatrial communication.…”

“…When HF, protein-losing enteropathy, or Fontan circulation failure are refractory to pharmacologic management and interventions, early referral for heart transplantation assessment should be undertaken. [171][172][173][174][175][176][177][178][179][180][181][182][183][184] This should be to a centre with expertise in heart transplantation in the Fontan population. Decision-making around the appropriate timing for transplantation and consideration of multiorgan transplantation is challenging.…”

Contemporary Management Strategies of Baffle Leaks in Adults with a Failing Systemic Right Ventricle Late after Atrial Switch: A Case Series and Literature Overview

“…While historically baffle complications were managed surgically, perioperative mortality for surgical baffle revision after the atrial switch procedure has been reported in up to 36% of cases [ 16 ]. Percutaneous interventions are the preferred option in these adult patients, given the usually high perioperative risk due to previous thoracotomies, extensive adhesions, and concomitant heart failure.…”

Atrial baffle stenting

“…In a report of their single‐center retrospective study of 20 patients treated between 1994 and 2016, Poterucha et al describe intravascular and hybrid stent placement for systemic and pulmonary venous baffle obstruction in patients who have undergone atrial switch repair for d‐transposition of the great arteries (d‐TGA). The study looked to assess the procedural success rate, clinical outcomes, and complications of this complex cohort.…”