Transcatheter pulmonary valve replacement after arterial switch operation

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Pediatric Cardiology

Background:

• Patients with d-transposition of the great arteries (d-TGA) after arterial switch operation (ASO) may develop right ventricular outflow tract (RVOT) dysfunction.
• Pulmonary regurgitation (PR) or stenosis are common complications requiring treatment, such as transcatheter pulmonary valve replacement (TPVR).
• Coronary artery compression is a potential contraindication for TPVR in this population.

Purpose of the Study:

• To assess the feasibility of TPVR in patients who have undergone ASO for d-TGA.
• To identify anatomical challenges that may preclude TPVR after ASO.
• To evaluate outcomes of TPVR in this specific patient group.

Main Methods:

• Retrospective multicenter cohort study.
• Inclusion of patients with RVOT dysfunction post-ASO undergoing cardiac catheterization for TPVR between 2008 and 2020.
• Analysis of TPVR success rates, adverse events, and precluding anatomical factors.

Main Results:

• TPVR was successful in 66% of 33 eligible patients, with significant reduction in RVOT gradient and PR.
• Coronary compression prevented TPVR in 24% of patients, and aortic root deformation in 6%.
• Seven patients required RVOT reintervention a median of 5.3 years post-TPVR.

Conclusions:

• TPVR is a feasible treatment for RVOT dysfunction in d-TGA patients post-ASO.
• Anatomical issues, particularly coronary compression and aortic root distortion, limit TPVR applicability in about one-third of cases.
• The rate of RVOT reintervention after TPVR in this ASO cohort appears higher than previously reported.