Combined pressure and volume loading for left ventricular training in patients with congenitally corrected transposition of the great arteries

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Abstract Submission 

Antonia Schulz (1), Viktoria Weixler (1), Marcus Kelm (2), Peter Kramer (2), Mi-Young Cho (3), Stanislav Ovroutski (2), Felix Berger (2), Joachim Photiadis (4)

(1) Deutsches Herzzentrum der Charité, Berlin, Germany, (2) Deutsches Herzzentrum der Charité, Berlin, NA, (3) German Heart Center Berlin, Berlin, Berlin, (4) N/A, N/A

Antonia Schulz    -  Contact Me
Deutsches Herzzentrum der Charité

Viktoria Weixler    -  Contact Me
Deutsches Herzzentrum der Charité

Marcus Kelm    -  Contact Me
Deutsches Herzzentrum der Charité

Peter Kramer    -  Contact Me
Deutsches Herzzentrum der Charité

Mi-Young Cho    -  Contact Me
German Heart Center Berlin

Stanislav Ovroutski    -  Contact Me
Deutsches Herzzentrum der Charité

Felix Berger    -  Contact Me
Deutsches Herzzentrum der Charité

Joachim Photiadis    -  Contact Me
N/A

Antonia Schulz    -  Contact Me
N/A

Objective: Patients with congenitally corrected transposition of the great arteries (ccTGA) and unconditioned left ventricles (LV) may become candidates for double switch operation (DSO) when undergoing LV training with pulmonary artery banding (PAB) ± atrial septectomy. The aim of the study was to assess the success of this concept.
Methods: The medical records of all patients with ccTGA who underwent LV training between 2012-2022 were retrospectively reviewed.
Results: Fifteen patients underwent LV training at a median age of 1.5 years (IQR 0.7-5.6). Baseline MRI was done in 11 and cardiac catheterization in 12 patients. The median LV mass index was 20.4 g/m2 (IQR 18.9-36.6), LV end-diastolic volume (LVEDV) index was 67.6 ml/m2 (IQR 40.6-97.1) and systolic LV/RV pressure ratio was 0.35 (IQR 0.31-0.5). In addition to PAB, atrial septectomy was performed in twelve patients (80%). Two patients (13%) already had a relevant shunt due to partial anomalous pulmonary venous drainage. The maximum PAB gradient was 41 mmHg (IQR 40-52). Median ICU and hospital stay were 1 day (IQR 1-3) and 6 days (IQR 5-8), respectively. One patient required ventricular assist device implantation 8 months after PAB and underwent heart transplantation. The patient died 3.6 years after PAB.
Of the 14 survivors, follow-up MRIs and cardiac catheterization were done in 12 patients, respectively. Two patients were evaluated by echocardiography. After a median of 1.9 years (IQR 0.8-4.4) median LV mass index increased to 38.5 g/m2 (IQR 25-49, P=0.004), LVEDV index remained at 71.4 ml/m2 (IQR 50.5-91.8, P=0.49) and systolic LV/RV pressure ratio increased to 0.94 (IQR 0.84-1.1, P=0.004) (Figure 1). Maximum PAB gradient increased to 59 mmHg (IQR 52-97, P=0.003).
So far, six patients (6/14, 43%) have met eligibility criteria for DSO (5 performed, 1 scheduled). Their age at time of PAB was 1.7 years (IQR 0.5-3.7) and time between PAB and DSO was 3.1 years (IQR 1.5-5.2). One patient required DSO takedown due to LV failure. Two patients (11 and 14 years at time of PAB) were considered non-responders and remained in NYHA class II with preserved cardiac function 5.5 and 4.6 years after PAB. Six patients (6/14, 43%) continue LV training after a median follow-up time of 1.1 years (IQR 0.7-1.9).
Conclusion: Combined pressure and volume loading resulted in significant increase in LV mass index and LV/RV pressure ratio. Among older patients there were non-responders who remained not suitable for DSO

Reconstruction of Complex Congenital Heart Disease