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. 2024 Oct 14;3(11):101327.
doi: 10.1016/j.jacadv.2024.101327. eCollection 2024 Nov.

30 Years' Experience in Percutaneous Pulmonary Artery Interventions in Transposition of the Great Arteries

Renée S Joosen  1 , Roel L F van der Palen  2   3 , Floris E A Udink Ten Cate  4 , Michiel Voskuil  5 , Gregor J Krings  1 , Regina Bökenkamp  2   3 , Mirella C Molenschot  1 , Nathan D Hahurij  2   3 , Michael G Dickinson  5 , Mark G Hazekamp  3   6 , Paul H Schoof  7 , Martijn G Slieker  1 , Bart Straver  2   3   8 , Nico A Blom  2   3   8 , Johannes M P J Breur  1
Affiliations

30 Years' Experience in Percutaneous Pulmonary Artery Interventions in Transposition of the Great Arteries

Renée S Joosen et al. JACC Adv. .

Abstract

Background: Pulmonary artery (PA) stenosis is common after arterial switch operation (ASO) for transposition of the great arteries (TGA). Differences between balloon angioplasty (BA) and stents on right ventricular (RV) and PA pressures are not well studied.

Objectives: The purpose of this study was to analyze percutaneous PA interventions' frequency after ASO, complications, and the effects of BA and stents on RV and PA pressures.

Methods: All TGA patients with ASO between 1977 and 2022 in 2 Dutch congenital heart centers were included in this multicenter retrospective study. Peri-operative ASO characteristics and pre-intervention and post-intervention invasive and echocardiographic data were analyzed.

Results: ASO was performed in 960 TGA patients, of which 888 survived 30 days and had complete follow-up. Seventy-seven (9%) underwent percutaneous PA interventions. Taussig-Bing anomaly (OR: 2.8; 95% CI: 1.228-6.168; P = 0.014), ASO time era 1990 to 1999 (OR: 4.7; 95% CI: 1.762-12.780; P = 0.002), and 2000 to 2009 (OR: 4.3; 95% CI: 1.618-11.330; P = 0.003) were independently associated with percutaneous PA interventions after ASO. Invasive post-interventional pressures and gradients were lower after stent implantation compared to BA (RV pressure: 47 ± 14 vs 58 ± 11; right PA-PA gradient: 11 ± 11 vs 25 ± 12, P < 0.05; RV/left ventricle pressure ratio: 0.4 ± 0.1 vs 0.6 ± 0.2, P < 0.001). Of the patients with unilateral PA stenosis (left PA: 41%, right PA: 59%), 77% showed increased RV pressure (>30 mm Hg) and RV/left ventricle pressure ratio improved post-intervention (0.5 ± 0.2 vs 0.6 ± 0.2, P < 0.05). Seventeen complications, most minor, were reported (13%). Two post-procedural deaths were reported.

Conclusions: Percutaneous PA interventions are common after ASO and can be performed safely but caution for serious complications is warranted. Unilateral PA stenosis can impact RV pressures. Stents may be more successful at treating PA stenosis compared to BA.

Keywords: arterial switch operation; intervention; pulmonary stenosis; transposition of the great arteries.

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Conflict of interest statement

This research was supported by the Netherlands Cardiovascular Research Initiative as part of the OUTREACH consortium: an initiative with support of the Dutch Heart Foundation and Hartekind, CVON2019-002. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Flowchart Percutaneous PA (Re)intervention in TGA Patients After ASO A flowchart of the number of procedures, the number of locations (LPA, RPA, or MPA) treated per procedure, and the type of procedure (Balloon, stent, dilatation of stent) during percutaneous PA (Re)interventions. ASO = arterial switch operation; FU = follow-up; LPA = left pulmonary artery; MPA = main pulmonary artery; PA = pulmonary artery; RPA = right pulmonary artery; TGA = transposition of the great arteries.
Figure 2
Figure 2
Invasive Measurements All Location Specific Percutaneous PA (Re)interventions Graphs show difference in invasive pre-interventional and post-interventional RV pressure (A and B), RV/LV pressure ratio (C and D), LPA-PA gradient (E and F), and RPA-PA gradient (G and H) between balloon angioplasty and stent implantation. BA = balloon angioplasty; LV = left ventricle; RV = right ventricle; other abbreviations as in Figure 1.
Central Illustration
Central Illustration
Pulmonary Artery Stenosis in Transposition of the Great Arteries Created in BioRender. Joosen, R. (2023) BioRender.com/j13u676. Abbreviations as in Figure 1.
See this image and copyright information in PMC

References

    1. Jatene A.D., Fontes V.F., Paulista P.P., et al. Anatomic correction of transposition of the great vessels. J Thorac Cardiovasc Surg. 1976;72(3):364–370. - PubMed
    1. Lecompte Y., Neveux J.Y., Leca F., et al. Reconstruction of the pulmonary outflow tract without prosthetic conduit. J Thorac Cardiovasc Surg. 1982;84(5):727–733. - PubMed
    1. Brickner M.E., Hillis L.D., Lange R.A. Congenital heart disease in adults. First of two parts. N Engl J Med. 2000;342(4):256–263. - PubMed
    1. Morgan C.T., Mertens L., Grotenhuis H., Yoo S.J., Seed M., Grosse-Wortmann L. Understanding the mechanism for branch pulmonary artery stenosis after the arterial switch operation for transposition of the great arteries. Eur Heart J Cardiovasc Imaging. 2017;18(2):180–185. - PubMed
    1. van der Palen R.L.F., Blom N.A., Kuipers I.M., et al. Long-term outcome after the arterial switch operation: 43 years of experience. Eur J Cardio Thorac Surg. 2021;59(5):968–977. - PMC - PubMed

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