Palliative pulmonary artery banding versus anatomic correction for congenitally corrected transposition of the great arteries with regressed morphologic left ventricle: Long-term results from a single center

摘要

Objective: We aimed to compare the long-term results between palliative pulmonary artery banding and anatomic correction for congenitally corrected transposition of the great arteries with regressed morphologic left ventricle.Methods: From 2003 to 2012, 40 consecutive patients underwent first-stage pulmonary artery banding. The second-stage operation-double switch-was performed in 15 patients (double-switch group). The other 25 patients retained pulmonary artery banding without further operation (pulmonary artery banding group). Inhospital mortality, long-term mortality, and heart function were studied as primary outcomes.Results: The median time of follow-up was 3.4 ± 0.7 years (range, 6 months-9.5 years). Overall survival rate was 66.7%in the double-switch group versus 96.0%in the pulmonary artery banding group (P = .03). The ratio of New York Heart Association functional class I-II (80.0% vs 95.9%; P = .02) and the mean functional left ventricle ejection fraction (51.4% ± 9.6% vs 61.0% ± 6.4%; P = .01) were higher in the pulmonary artery banding group at follow-up. In univariate analysis, age at pulmonary artery banding was the only risk factor for late deaths (odds ratio, 7.30; P = .01) and left ventricle dysfunction (odds ratio, 4.77; P = .03) after the double switch. For patients who experienced prolonged pulmonary artery banding, mean oxygen saturation was 95% ± 3.1% and the trans-banding pressure gradient was 46.9 ± 21.5 mm Hg.Conclusions: In patients with congenitally corrected transposition of the great arteries with deconditioned morphologic left ventricle pulmonary artery banding may be considered an ideal procedure because it allows left ventricle training while improving tricuspid regurgitation. Compared with the double-switch procedure after pulmonary artery banding, prolonged palliative pulmonary artery banding provided a lower mortality rate and indicated better cardiac function.