title: Intravascular and hybrid intraoperative stent placement for baffle obstruction in transposition of the great arteries after atrial switch.
abstract: OBJECTIVE
  To report our experience with intravascular and hybrid intra-operative stent placement for baffle obstruction in patients with complete transposition of the great arteries (TGA) after the atrial switch (Mustard/Senning) operation.
  
  
  BACKGROUND
  Venous baffle obstruction is a challenging complication after atrial switch operation in patients with TGA. Traditional treatment options include intravascular stenting or surgery.
  
  
  METHODS
  A retrospective analysis of Mayo Clinic's electronic medical record was completed to identify consecutive pediatric and adult patients with TGA after atrial switch who underwent baffle stent implantation from 1994 to 2015.
  
  
  RESULTS
  Overall, 64 patients were referred for cardiac catheterization, in whom 47 (73%) were noted to have hemodynamic and angiographic evidence of baffle obstruction. A total of 20 patients mean age 33 (range: 8-46) years old underwent stent implantation of baffle stenosis at a mean of 33 (range: 7.5-45) years after initial atrial switch operation (Mustard, n = 19; Senning, n = 1). Overall, 27 baffles were stented in 20 patients via the following approaches: intravascular (17); hybrid surgical (3); staged intravascular & hybrid (2). Sites of stent placement were: superior vena cava (SVC) (13); inferior vena cava (IVC) (9); pulmonary venous baffle (5). Three patients had stent placement in the SVC and IVC baffles during the same procedure. Procedural adverse events occurred in 2/22 cases (9%) including creation of unintentional baffle leak (n = 1) and stent migration (n = 1). There was no procedure-related mortality. At follow-up (median 2, range 0.02-10 years), significantly improved NYHA class and mean Doppler baffle gradient were demonstrated (P < 0.05). Mild baffle re-stenosis (mean Doppler gradient; 2-3 mmHg) occurred in two patients who have not required re-intervention. Trivial baffle leak was noted in four patients. Baffle re-intervention was only occurred in one patient. One patient with pre-procedural Class IV symptoms died 3.5 months after stent implantation.
  
  
  CONCLUSIONS
  This study is the largest reported experience of intravascular and intra-operative hybrid stent placement for patients with TGA after atrial switch. Transcatheter and minimally invasive hybrid intraoperative surgical stent placement are an effective strategy for relief of systemic and pulmonary venous baffle obstruction. © 2016 Wiley Periodicals, Inc.
authors: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota.
authors: Joseph T
authors: JT
authors: Poterucha
authors: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota.
authors: Nathaniel W
authors: NW
authors: Taggart
authors: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota.
authors: Jonathan N
authors: JN
authors: Johnson
authors: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota.
authors: Bryan C
authors: BC
authors: Cannon
authors: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota.
authors: Allison K
authors: AK
authors: Cabalka
authors: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota.|Division of Cardiovascular Diseases, Department of Medicine, Rochester, Minnesota.
authors: Donald J
authors: DJ
authors: Hagler
authors: Division of Cardiovascular Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.
authors: Joseph A
authors: JA
authors: Dearani
authors: Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Rochester, Minnesota.|Division of Cardiovascular Diseases, Department of Medicine, Rochester, Minnesota.
authors: Frank
authors: F
authors: Cetta
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D000069278:Arterial Switch Operation / Q000009:adverse effects*; D002648:Child; D015150:Echocardiography, Doppler; D019560:Echocardiography, Three-Dimensional; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019233:Retreatment; D012189:Retrospective Studies; D015607:Stents; D014188:Transposition of Great Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult
keywords: Mustard; Senning; baffle obstruction; hybrid stent placement; transposition of the great arteries