15. ARTERIAL SWITCH AFTER FAILED ATRIAL BAFFLE PROCEDURES FOR TRANSPOSITION
Constantine Mavroudis*, Carl L. Backer
Childrens Memorial Hospital, Northwestern University Medical School
Chicago, Illinois, USA
OBJECTIVES
Late failure of the systemic right ventricle (RV) in patients with transposition (TGA) poses significant management problems. We reviewed our experience with staged conversion to arterial switch (ASO) after failed baffle procedures.
MATERIAL AND METHODS
Between 1984 and 1998, 10 patients underwent pulmonary artery band (PAB) without mortality to prepare the left ventricle (LV) for ASO conversion. One additional patient had subpulmonic stenosis and was naturally prepared. Mean age at PAB was 11.6 years (range 1.9-23 yrs). Three patients underwent reoperation to tighten the PAB. Mean interval from PAB to ASO was 1.4 yrs.
RESULTS
Five patients had ASO conversion with one death. Recent surgical modifications were used to prevent neoaortic valve insufficiency and to cryoablate atrial reentry tachycardia. Four patients developed biventricular failure after PAB; two had cardiac transplantation (OCT), one died awaiting OCT, and one awaits OCT. The other two patients are awaiting ASO conversion.
CONCLUSION
Patients with RV failure after atrial baffle operations can undergo successful staged conversion to ASO. Surgical modifications can address the problems of neoaortic insufficiency and persistent atrial arrhythmias. Those who develop biventricular failure after PAB will require cardiac transplantation.
