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

Abstract

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). 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. CONCLUSIONS: Stent 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.