The palliative pulmonary banding may provide better outcomes than anatomical correction of congenitally corrected transposition of the great arteries with involuted morphologic left ventricle

Abstract

Background: Recently sub-optimal outcomes were reported after the second stage anatomical correction of congenitally corrected transposition of the great arteries (cc-TGA) with morphologic Left Ventricular (mLV) regression. We followed up all the patients underwent Pulmonary Artery Banding (PAB) with/without the second stage Double Switch (DS) operation to compare the outcomes between the DS and the prolonged palliative PAB. Methods: From 2005 to 2012, 40 consecutive patients diagnosed with cc-TGA with morphological LV regression were included in this retrospective cohort study. Every patient underwent the first stage PAB. The second stage DS was performed in 15 patients (group I) while the palliative PAB was prolonged in the other 25 patients (group II). The median age at PAB was 3.1 years (range, 3 months to 8 years) and the mean weight at PAB was 11.5kg (range, 5.0-21.5kg). Mean follow-up was 3.4±0.7years (range, 6 months to 9.5 years). Results: Overall survival rate was 66.7% in group I vs. 96.0% in group II (P=0.03). Three patients had at least moderate neo-aortic regurgitation at latest echocardiography and 2 patients had severe post-double switch operative arrhythmias in group I. The ratio of NYHA I–II (80.0% in group I vs. 95.9% in group II, P=0.02) and the mean systemic ventricular ejection fraction (51.4±9.6% in group I vs. 61.0±6.4% in group II, P=0.006) were higher in group II at follow up. No PAB relating cyanosis or ventricular dysfunction was found in group II. The trans-banding pressure gradient was 46.9±21.5mmHg in group II. View this table: Outcomes between groups Conclusions: The results of the mLV retraining followed by a DS procedure for cc-TGA with morphological LV regression were unsatisfactory. Compared to the DSO, the prolonged pallative PAB provided a lower mortality and indicated a better cardiac function. As a result, performing the DSO on these patients needs careful consideration and the prolonged pallative PAB may be considered as an ideal procedure. Further follow-up is warranted with a focus on the exercise tolerance.