Percutaneous interventions in high‐risk patients following mustard repair of transposition of the great arteries

Abstract

ObjectivesTo assess safety, efficacy, and intermediate term outcomes of percutaneous interventions in Mustard patients.BackgroundBaffle leaks and obstruction are present in 20% of Mustard survivors. Surgical reintervention is associated with high mortality.MethodsRetrospective review of percutaneous interventions performed at three adult congenital catheterization programs.ResultsOverall, 26 catheterizations and 29 interventions were performed in 22 patients (mean age 32.4 ± 8.3 years). Previous laser pacemaker lead extraction was successful in seven of seven procedures where the lead was at risk. Stent placement was successful in all 18 patients with systemic venous baffle (SVB) obstruction (mean gradient: 6.2 ± 3.4–0.6 ± 1.0 mm Hg; P < 0.01, narrowest diameter 4.5 ± 4.5–17.1 ± 3.9 mm; P < 0.01). Balloon angioplasty was performed in two patients for pulmonary venous baffle (PVB) obstruction with mixed results. Baffle leak interventions included device occlusion (n = 6), coil occlusion (n = 1), and covered stent occlusion (n = 3). Postprocedural residual leaks were demonstrated in three of eight. In two of the three the residual leak was not appreciable at 1‐year follow‐up. No patient experienced leak or obstruction related symptom recurrence (mean follow‐up: 33.4 ± 29.5 months). Complications included one death secondary to ventricular arrhythmia 2 days after PVB angioplasty and device related inferior SVB obstruction with resolution following stent placement.ConclusionsStent placement for SVB obstruction following Mustard repair is effective and likely safer than surgical intervention. Baffle leak occlusion can be safely accomplished but residual leaks are common in the short term. © 2012 Wiley Periodicals Inc.

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

“…Modern treatment options include intravascular stenting or surgical revision . Hill et al reported a multicenter case series including 19 patients who had undergone successful percutaneous stent implantation of systemic venous baffle obstructions with mid‐term follow‐up data . The largest single center series to describe baffle intervention included 24 patients who underwent either stent implantation or balloon dilatation alone of only the superior vena cava baffle .…”

“…Perioperative mortality in patients referred for surgical baffle revision has been reported to be 36% . Modern treatment options include intravascular stenting or surgical revision . Hill et al reported a multicenter case series including 19 patients who had undergone successful percutaneous stent implantation of systemic venous baffle obstructions with mid‐term follow‐up data .…”

Mustard baffle obstruction and leak – How successful are percutaneous interventions in adults?

“…[22–36] Two case series have more recently demonstrated good short and medium-term outcomes with these procedures. [37,38] The first case series came out of Germany, where 12 of 13 patients with a median age of 20.8 years underwent 14 successful procedures including baffle stent and septal occluder placement without complication, baffle rupture, or hemorrhage. In this group, at 21 months of follow-up there was no recurrent stenosis or leak.…”

“…The authors concluded that stent placement for baffle obstruction is effective and likely safer than surgical intervention, and baffle leak occlusion is safely treated from a percutaneous approach, albeit the presence of residual leak in the short-term. [38]. …”

Heart Failure in Adult Congenital Heart Disease

“…For some patients, relief of baffle leaks and/or stenosis can translate to significant improvements in functional class and hemodynamics. 11 Percutaneous interventions include balloon angioplasty for baffle stenosis with or without stent placement. Baffle leaks can also be treated with deployment of a covered stent.…”