Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstructionCentral MessagePerspective
Objective: Patients with complex single-ventricle anatomy with transposed great arteries and systemic outflow obstruction (SV-TGA-SOO) undergo varied initial palliation with ultimate goal of Fontan circulation. We examine a longitudinal experience with multiple techniques, including the largest publ...
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Elsevier
2023-10-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250723002055 |
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| author | Alyssa B. Kalustian, MD Zachary A. Spigel, MD Christopher E. Greenleaf, MD Tam T. Doan, MD Alejandra I. Chavez, MD Iki Adachi, MD Jeffrey S. Heinle, MD Ziyad M. Binsalamah, MD |
| author_facet | Alyssa B. Kalustian, MD Zachary A. Spigel, MD Christopher E. Greenleaf, MD Tam T. Doan, MD Alejandra I. Chavez, MD Iki Adachi, MD Jeffrey S. Heinle, MD Ziyad M. Binsalamah, MD |
| author_sort | Alyssa B. Kalustian, MD |
| collection | DOAJ |
| description | Objective: Patients with complex single-ventricle anatomy with transposed great arteries and systemic outflow obstruction (SV-TGA-SOO) undergo varied initial palliation with ultimate goal of Fontan circulation. We examine a longitudinal experience with multiple techniques, including the largest published cohort following palliative arterial switch operation (pASO), to describe outcomes and decision-making factors. Methods: Neonates with SV-TGA-SOO who underwent initial surgical palliation from 1995 to 2022 at a single institution were retrospectively reviewed. Results: In total, 71 neonates with SV-TGA-SOO underwent index surgical palliation at a median age of 7 days (interquartile range, 6-10) by pASO (n = 23), pulmonary artery band (PAB) with or without arch repair (n = 25), or modified Norwood with Damus–Kaye–Stansel aortopulmonary amalgamation (n = 23). Single-ventricle pathology included double-inlet left ventricle (n = 37, 52%), tricuspid atresia (n = 27, 38%), and others (n = 7, 10%). All mortalities (n = 5, 7%) occurred in the first interstage period after PAB (n = 3) and Norwood (n = 2). Subaortic obstruction in the PAB group was addressed by operative resection (n = 10 total, 7 at index operation) and/or delayed aortopulmonary amalgamation (n = 13, 52%). Two patients with pASO (9%) had early postoperative coronary complications, 1 requiring operative revision. Median follow-up for survivors was 10.4 years (interquartile range, 4.5-16.6 years). Comparing patients by their initial palliation type, notable significant differences included size of bulboventricular foramen, weight at initial operation, operation duration, postoperative length of stay, time to second-stage palliation, multiple pulmonary artery reinterventions, and left pulmonary artery interventions. There were no significant differences in overall survival, Fontan completion, reintervention-free survival in the first interstage period, pulmonary artery reintervention-free survival, long-term systemic valve competency, or ventricular dysfunction. Conclusions: Excellent mid- to long-term outcomes are achievable following neonatal palliation for SV-TGA-SOO via pASO, PAB, and modified Norwood, with comparable survival and Fontan completion. Initial palliation strategy should be individualized to optimize anatomy and physiology for successful Fontan by ensuring an unobstructed subaortic pathway and accessible pulmonary arteries. pASO is a reasonable strategy to consider for these heterogeneous lesions. |
| format | Article |
| id | doaj-art-c94a7fc1337a4e86bb9c135609447bb8 |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | Elsevier |
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| series | JTCVS Techniques |
| spelling | doaj-art-c94a7fc1337a4e86bb9c135609447bb82025-08-20T04:01:57ZengElsevierJTCVS Techniques2666-25072023-10-012114917710.1016/j.xjtc.2023.06.006Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstructionCentral MessagePerspectiveAlyssa B. Kalustian, MD0Zachary A. Spigel, MD1Christopher E. Greenleaf, MD2Tam T. Doan, MD3Alejandra I. Chavez, MD4Iki Adachi, MD5Jeffrey S. Heinle, MD6Ziyad M. Binsalamah, MD7Congenital Heart Surgery, Texas Children's Hospital–Baylor College of Medicine, Houston, TexGeneral Surgery, Allegheny Health Network, Pittsburgh, PaCongenital Heart Surgery, Pediatric Surgery, The University of Texas Health Science Center at Houston, Houston, TexPediatric Cardiology, Texas Children's Hospital–Baylor College of Medicine, Houston, TexPediatric Cardiology, Texas Children's Hospital–Baylor College of Medicine, Houston, TexCongenital Heart Surgery, Texas Children's Hospital–Baylor College of Medicine, Houston, TexCongenital Heart Surgery, Texas Children's Hospital–Baylor College of Medicine, Houston, TexCongenital Heart Surgery, Texas Children's Hospital–Baylor College of Medicine, Houston, Tex; Address for reprints: Ziyad M. Binsalamah, MD, Division of Congenital Heart Surgery, Legacy Tower Heart Center, Baylor College of Medicine and Texas Children's Hospital, 6651 Main St, Houston, TX 77030.Objective: Patients with complex single-ventricle anatomy with transposed great arteries and systemic outflow obstruction (SV-TGA-SOO) undergo varied initial palliation with ultimate goal of Fontan circulation. We examine a longitudinal experience with multiple techniques, including the largest published cohort following palliative arterial switch operation (pASO), to describe outcomes and decision-making factors. Methods: Neonates with SV-TGA-SOO who underwent initial surgical palliation from 1995 to 2022 at a single institution were retrospectively reviewed. Results: In total, 71 neonates with SV-TGA-SOO underwent index surgical palliation at a median age of 7 days (interquartile range, 6-10) by pASO (n = 23), pulmonary artery band (PAB) with or without arch repair (n = 25), or modified Norwood with Damus–Kaye–Stansel aortopulmonary amalgamation (n = 23). Single-ventricle pathology included double-inlet left ventricle (n = 37, 52%), tricuspid atresia (n = 27, 38%), and others (n = 7, 10%). All mortalities (n = 5, 7%) occurred in the first interstage period after PAB (n = 3) and Norwood (n = 2). Subaortic obstruction in the PAB group was addressed by operative resection (n = 10 total, 7 at index operation) and/or delayed aortopulmonary amalgamation (n = 13, 52%). Two patients with pASO (9%) had early postoperative coronary complications, 1 requiring operative revision. Median follow-up for survivors was 10.4 years (interquartile range, 4.5-16.6 years). Comparing patients by their initial palliation type, notable significant differences included size of bulboventricular foramen, weight at initial operation, operation duration, postoperative length of stay, time to second-stage palliation, multiple pulmonary artery reinterventions, and left pulmonary artery interventions. There were no significant differences in overall survival, Fontan completion, reintervention-free survival in the first interstage period, pulmonary artery reintervention-free survival, long-term systemic valve competency, or ventricular dysfunction. Conclusions: Excellent mid- to long-term outcomes are achievable following neonatal palliation for SV-TGA-SOO via pASO, PAB, and modified Norwood, with comparable survival and Fontan completion. Initial palliation strategy should be individualized to optimize anatomy and physiology for successful Fontan by ensuring an unobstructed subaortic pathway and accessible pulmonary arteries. pASO is a reasonable strategy to consider for these heterogeneous lesions.http://www.sciencedirect.com/science/article/pii/S2666250723002055palliative arterial switchcomplex single ventriclesingle-ventricle managementdouble-inlet left ventricletricuspid atresiatransposition |
| spellingShingle | Alyssa B. Kalustian, MD Zachary A. Spigel, MD Christopher E. Greenleaf, MD Tam T. Doan, MD Alejandra I. Chavez, MD Iki Adachi, MD Jeffrey S. Heinle, MD Ziyad M. Binsalamah, MD Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstructionCentral MessagePerspective JTCVS Techniques palliative arterial switch complex single ventricle single-ventricle management double-inlet left ventricle tricuspid atresia transposition |
| title | Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstructionCentral MessagePerspective |
| title_full | Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstructionCentral MessagePerspective |
| title_fullStr | Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstructionCentral MessagePerspective |
| title_full_unstemmed | Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstructionCentral MessagePerspective |
| title_short | Comparing palliation strategies for single-ventricle anatomy with transposed great arteries and systemic outflow obstructionCentral MessagePerspective |
| title_sort | comparing palliation strategies for single ventricle anatomy with transposed great arteries and systemic outflow obstructioncentral messageperspective |
| topic | palliative arterial switch complex single ventricle single-ventricle management double-inlet left ventricle tricuspid atresia transposition |
| url | http://www.sciencedirect.com/science/article/pii/S2666250723002055 |
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