Joosen Renée S, van der Palen Roel L F, Udink Ten Cate Floris E A, Voskuil Michiel, Krings Gregor J, Bökenkamp Regina, Molenschot Mirella C, Hahurij Nathan D, Dickinson Michael G, Hazekamp Mark G, Schoof Paul H, Slieker Martijn G, Straver Bart, Blom Nico A, Breur Johannes M P J
Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.
JACC Adv. 2024 Oct 14;3(11):101327. doi: 10.1016/j.jacadv.2024.101327. eCollection 2024 Nov.
Pulmonary artery (PA) stenosis is common after arterial switch operation (ASO) for transposition of the great arteries (TGA). Differences between balloon angioplasty (BA) and stents on right ventricular (RV) and PA pressures are not well studied.
The purpose of this study was to analyze percutaneous PA interventions' frequency after ASO, complications, and the effects of BA and stents on RV and PA pressures.
All TGA patients with ASO between 1977 and 2022 in 2 Dutch congenital heart centers were included in this multicenter retrospective study. Peri-operative ASO characteristics and pre-intervention and post-intervention invasive and echocardiographic data were analyzed.
ASO was performed in 960 TGA patients, of which 888 survived 30 days and had complete follow-up. Seventy-seven (9%) underwent percutaneous PA interventions. Taussig-Bing anomaly (OR: 2.8; 95% CI: 1.228-6.168; = 0.014), ASO time era 1990 to 1999 (OR: 4.7; 95% CI: 1.762-12.780; = 0.002), and 2000 to 2009 (OR: 4.3; 95% CI: 1.618-11.330; = 0.003) were independently associated with percutaneous PA interventions after ASO. Invasive post-interventional pressures and gradients were lower after stent implantation compared to BA (RV pressure: 47 ± 14 vs 58 ± 11; right PA-PA gradient: 11 ± 11 vs 25 ± 12, < 0.05; RV/left ventricle pressure ratio: 0.4 ± 0.1 vs 0.6 ± 0.2, < 0.001). Of the patients with unilateral PA stenosis (left PA: 41%, right PA: 59%), 77% showed increased RV pressure (>30 mm Hg) and RV/left ventricle pressure ratio improved post-intervention (0.5 ± 0.2 vs 0.6 ± 0.2, < 0.05). Seventeen complications, most minor, were reported (13%). Two post-procedural deaths were reported.
Percutaneous PA interventions are common after ASO and can be performed safely but caution for serious complications is warranted. Unilateral PA stenosis can impact RV pressures. Stents may be more successful at treating PA stenosis compared to BA.
在大动脉转位（TGA）的动脉调转术（ASO）后，肺动脉（PA）狭窄很常见。球囊血管成形术（BA）和支架对右心室（RV）及PA压力的差异尚未得到充分研究。
本研究旨在分析ASO后经皮PA介入治疗的频率、并发症，以及BA和支架对RV和PA压力的影响。
本多中心回顾性研究纳入了1977年至2022年期间在2家荷兰先天性心脏病中心接受ASO的所有TGA患者。分析围手术期ASO特征以及介入治疗前和介入治疗后的有创和超声心动图数据。
960例TGA患者接受了ASO，其中888例存活30天并进行了完整随访。77例（9%）接受了经皮PA介入治疗。陶西格-宾畸形（OR：2.8；95%CI：1.228 - 6.168；P = 0.014）、1990年至1999年的ASO时期（OR：4.7；95%CI：1.762 - 12.780；P = 0.002）以及2000年至2009年（OR：4.3；95%CI：1.618 - 11.330；P = 0.003）与ASO后经皮PA介入治疗独立相关。与BA相比，支架植入后介入治疗后的有创压力和压差更低（RV压力：47±14 vs 58±11；右PA - PA压差：11±11 vs 25±12，P<0.05；RV/左心室压力比：0.4±0.1 vs 0.6±0.2，P<0.001）。在单侧PA狭窄患者中（左PA：41%，右PA：59%），77%的患者RV压力升高（>30 mmHg），且介入治疗后RV/左心室压力比有所改善（0.5±0.2 vs 0.6±0.2，P<0.05）。报告了17例并发症，大多为轻微并发症（13%）。报告了2例术后死亡。
ASO后经皮PA介入治疗很常见，且可安全进行，但需警惕严重并发症。单侧PA狭窄可影响RV压力。与BA相比，支架在治疗PA狭窄方面可能更成功。
