Impact of age and duration of banding on left ventricular preparation before anatomic repair for congenitally corrected transposition of the great arteries

Abstract

Background: The optimal age and duration of left ventricular (LV) training in congenitally corrected transposition (ccTGA) with an unprepared LV is unknown. The objective of this study was to review the effect of age at pulmonary artery banding (PAB) and duration of ventricular training on LV function and aortic regurgitation (AR) after anatomic repair.

Methods: The medical records of all patients who underwent PA banding for LV training between 1998 and 2011 were retrospectively reviewed. The primary end points were moderate or more LV dysfunction and moderate or more AR after anatomic repair.

Results: During the study period, 25 patients with ccTGA underwent PAB for LV preparation. There was 1 early death. Eighteen patients underwent anatomic repair at a median of 10 months (range, 2 weeks to 11 years) from PAB. At the most recent follow-up after anatomic repair, moderate AR developed in 1 patient, and moderate or more LV dysfunction developed in 4. LV dysfunction developed in 4 of 6 patients banded after 2 years of age, compared with 0 of 12 patients banded before 2 years (p = 0.005). After anatomic repair, LV dysfunction developed in 4 of 7 patients repaired after age 3 years compared with 0 of 11 repaired before 3 years (p = 0.01).

Conclusions: Early PAB strategy is associated with favorable LV and neoaortic valve function after anatomic repair for ccTGA with an unprepared LV. Candidates for anatomic repair who require LV training should be referred early in infancy for consideration of appropriate timing of PAB.

Keywords: 20.