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

Published on Feb 1, 2017in Catheterization and Cardiovascular Interventions2.044
· DOI :10.1002/CCD.26783
Joseph T. Poterucha1
Estimated H-index: 1
(UR: University of Rochester),
Nathaniel W. Taggart14
Estimated H-index: 14
(UR: University of Rochester)
+ 5 AuthorsFrank Cetta46
Estimated H-index: 46
(UR: University of Rochester)
Sources
Abstract
Objectives To report our experience with intravascular and hybrid intra-operative stent placement for baffle obstruction in patients with complete transposition of the great arteries (TGA) after the atrial switch (Mustard/Senning) operation. Background Venous baffle obstruction is a challenging complication after atrial switch operation in patients with TGA. Traditional treatment options include intravascular stenting or surgery. Methods A retrospective analysis of Mayo Clinic's electronic medical record was completed to identify consecutive pediatric and adult patients with TGA after atrial switch who underwent baffle stent implantation from 1994 to 2015. Results Overall, 64 patients were referred for cardiac catheterization, in whom 47 (73%) were noted to have hemodynamic and angiographic evidence of baffle obstruction. A total of 20 patients mean age 33 (range: 8–46) years old underwent stent implantation of baffle stenosis at a mean of 33 (range: 7.5–45) years after initial atrial switch operation (Mustard, n = 19; Senning, n = 1). Overall, 27 baffles were stented in 20 patients via the following approaches: intravascular (17); hybrid surgical (3); staged intravascular & hybrid (2). Sites of stent placement were: superior vena cava (SVC) (13); inferior vena cava (IVC) (9); pulmonary venous baffle (5). Three patients had stent placement in the SVC and IVC baffles during the same procedure. Procedural adverse events occurred in 2/22 cases (9%) including creation of unintentional baffle leak (n = 1) and stent migration (n = 1). There was no procedure-related mortality. At follow-up (median 2, range 0.02–10 years), significantly improved NYHA class and mean Doppler baffle gradient were demonstrated (P < 0.05). Mild baffle re-stenosis (mean Doppler gradient; 2–3 mmHg) occurred in two patients who have not required re-intervention. Trivial baffle leak was noted in four patients. Baffle re-intervention was only occurred in one patient. One patient with pre-procedural Class IV symptoms died 3.5 months after stent implantation. Conclusions 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.
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#2Marcus S. Schamberger (IU: Indiana University)H-Index: 11
Last. Mark H. Hoyer (IU: Indiana University)H-Index: 11
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We present a patient with a history of Mustard repair for transposition of the great arteries. The patient presented with complete inferior venous baffle obstruction and a large baffle leak after several years of cyanosis. Complete relief of the obstruction and exclusion of the baffle leak were accomplished with the use of a combination of bare metal stenting and the Gore® Excluder® aortic extender. To our knowledge, this represents the first reported use of the Gore® Excluder® aortic extender i...
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#1Dhaval R. Parekh (BCM: Baylor College of Medicine)H-Index: 12
#2Marcelo S. CabreraH-Index: 1
Last. Frank F. Ing (SC: University of Southern California)H-Index: 25
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We report a case of simultaneous transcatheter systemic and pulmonary venous baffle obstruction stenting in a post operative Mustard patient with d-transposition of the great arteries. © 2015 Wiley Periodicals, Inc.
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Objectives We sought to review our current philosophy that all primary invasive electrophysiologic (EP) studies in patients with atrial switch procedures (ASPs) should undergo hemodynamic evaluation and have interventional expertise available. Background Patients who have undergone an ASP for dextro-transposition of the great arteries have a high incidence of both hemodynamic and EP sequelae. We present our data to support the combined assessment approach for these patients. Methods Hemodynamic ...
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#1Kevin D. Hill (Duke University)H-Index: 32
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Last. John F. Rhodes (Duke University)H-Index: 25
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Objectives To assess safety, efficacy, and intermediate term outcomes of percutaneous interventions in Mustard patients. Background Baffle leaks and obstruction are present in 20% of Mustard survivors. Surgical reintervention is associated with high mortality. Methods Retrospective review of percutaneous interventions performed at three adult congenital catheterization programs. Results Overall, 26 catheterizations and 29 interventions were performed in 22 patients (mean age 32.4 ± 8.3 years). P...
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Background There are limited published data regarding the percutaneous extraction of device leads jailed by a venous stent. Objective In this study we assessed the feasibility and safety of percutaneous extraction of stented device leads. Methods We reviewed our experience percutaneously extracting 7 chronically implanted device leads jailed to the wall of the left innominate and/or subclavian veins by a previously placed stent. Results All leads were successfully extracted by using a percutaneo...
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#1Kevin D. Hill (Duke University)H-Index: 32
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We present two patients with a history of Mustard repair of transposition of the great arteries. Both patients presented with exertional limitation and demonstrated superior systemic venous baffle obstruction as well as multiple baffle leaks. In both patients stent relief of obstruction and baffle leak exclusion was accomplished using a combination of bare metal stents and the aortic extension portion of the Gore Excluder® covered stent (W.L. Gore and Associates, Flagstaff, Arizona). © 2010 Wile...
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#1Theodore F. Saad (Christiana Care Health System)H-Index: 12
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Purpose: Symptomatic central vein stenosis commonly occurs when cardiac rhythm management device (CRMD) leads are placed via the subclavian vein ipsilateral to arteriovenous (AV) hemodialysis (HD) access. The purposes of this study were to determine the outcomes, complications, and patency following stenting of CRMD lead-associated central vein stenosis or occlusion, and to determine the effect of stents on CRMD function. Methods: Fourteen HD patients with AV access and an ipsilateral CRMD were ...
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Pulmonary venous pathway obstruction is a late complication of the atrial switch operation for transposition of the great arteries. Gaining peripheral access to the pulmonary venous baffle obstruction to treat the obstruction with stent deployment is difficult if not impossible. We present three patients in which we used hybrid procedures in the operating room to relieve the pulmonary venous pathway obstructions.
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Percutaneous branch pulmonary artery (PA) stenting can be challenging, especially in patients with stenosis of the right ventricular (RV) outflow tract or tortuous PA branches. In these cases, a hybrid procedure deploying PA stent(s) during cardiac surgery provides an alternative to relieve branch PA stenosis. The Mayo Clinic Congenital Cardiac surgical database was used to identify all patients having hybrid PA stent procedures. Retrospective analysis of clinical data, procedural details, and o...
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#1Aphrodite Tzifa (Harvard University)H-Index: 14
#1Aphrodite Tzifa (Harvard University)H-Index: 2
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Objectives The purpose of this research was to investigate the causes and symptoms of superior vena cava (SVC) obstruction or occlusion and report on the long-term results of transcatheter therapy. Background Information on transcatheter therapy for SVC obstruction is limited. Methods Superior vena cava catheterization interventions between August 1984 and April 2006 were reviewed. Patients were divided into 2 subgroups depending on whether or not they had previously undergone congenital cardiac...
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Abstract Although the arterial switch operation has become the standard form of surgical repair for complete transposition of the great arteries, a large number of adults post-atrial switch are still followed in current practice. Pulmonary venous baffle obstruction is a well-known complication of the atrial switch operation, mimicking heart failure. Its recognition is important as it is a potentially treatable disease. In the past, retrograde pulmonary venous atrium (PVA)/pulmonary venous baffle...
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#1Matthew Carazo (Emory University)H-Index: 2
#1Matthew R. Carazo (Emory University)H-Index: 3
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Transposition of the great arteries (TGA) is a common congenital cardiac malformation, in which many patients survive into adulthood. From the 1960s through much of the 1980s, the majority of those with D-TGA were repaired with an atrial switch procedure, in which the right ventricle (RV) remains the systemic ventricle. Congenitally corrected TGA patients often remain with a systemic RV. In these patients, heart failure risks result from residual sequelae of childhood repair, which often include...
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Abstract Objectives This study sought to assess the feasibility, safety, and outcomes of a stepwise combined percutaneous approach that includes transvenous lead extraction (TLE) followed by baffle stenting and device reimplantation in patients with D-transposition of the great arteries (D-TGA) and atrial baffle dysfunction. Background Management of baffle leak or stenosis in patients with D-TGA and atrial switch surgery is challenging in the presence of transvenous cardiac implantable electroni...
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#1Kaley H. Garner (UCF: University of Central Florida)H-Index: 3
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Cardiovascular disease (CVD) resulting from atypical cardiac structures continues to be a leading health concern despite advancements in diagnostic imaging and surgical techniques. However, the ability to visualize spatial relationships using current technologies remains a challenge. Therefore, 3D modeling has gained significant interest to understand complex and atypical cardiovascular disorders. Moreover, 3D modeling can be personalized and patient-specific. 3D models have been demonstrated to...
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#1Jason H. Anderson (Mayo Clinic)H-Index: 31
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Purpose of reviewPatients with complete and congenitally corrected transposition of the great arteries commonly survive into adulthood and present with a vast array of clinical residua.Recent findingsEchocardiography remains the primary imaging modality in the routine assessment of the adult with tr
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: Adults with congenital heart disease are a growing population with increasingly more complex disease, in large part due to improvements in delivery of care to the pediatric population. Cardiac catheterization is an integral component of diagnosis and management in these patients. Careful attention to detail and a thorough understanding of intracardiac hemodynamics are critical to performing complete diagnostic evaluations. This article outlines the most commonly encountered lesions with guidel...
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