Transcatheter Mustard Revision Using Endovascular Graft Prostheses

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Medical Device Technology

Background:

• The Mustard procedure, a complex surgical repair for cyanotic heart disease, can result in baffle leaks.
• Large baffle leaks pose significant risks, especially in patients with high surgical comorbidities.
• Current treatment options for such leaks may be limited or carry substantial risks.

Observation:

• A high-surgical-risk patient with large Mustard baffle leaks was treated using percutaneously inserted, transcatheter endovascular graft prostheses.
• Three-dimensional-printed models were utilized for procedural planning and feasibility assessment.
• Telescoping graft extensions were deployed in the systemic venous pathways, and an atrial septal defect occluder device addressed a separate leak.

Findings:

• Successful exclusion of large Mustard baffle leaks was achieved using a transcatheter endovascular graft approach.
• The use of 3D-printed models facilitated precise procedural planning and execution.
• A combined strategy involving endovascular grafts and an occluder device effectively managed multiple leak sites.

Implications:

• Percutaneous transcatheter endovascular grafting presents a promising, less invasive alternative for managing complex baffle leaks post-Mustard repair.
• This technique may be particularly beneficial for patients deemed unsuitable for conventional surgical reintervention.
• Further research is warranted to establish the long-term efficacy and safety of this innovative approach in a broader patient population.