Arterial switch operation after left ventricular retraining with ductal stent: Our experience

Late-presenting transposition of the great arteries (TGAs) with an intact ventricular septum is characterized by left ventricular (LV) regression, making primary arterial switch operation (ASO) unsafe. Ductal stenting offers a less invasive alternative compared to conventional LV retraining using pulmonary artery banding and Blalock-Taussig-Thomas shunt. We analyzed outcomes of ASO following ductal stenting for LV retraining in six consecutive TGA children (median weight 3.3 kg). Median age at stenting and at surgery was 2 months and 2.5 months, respectively. The median interval from stenting to surgery was 33 days (8-238 days). LV mass increased significantly from 31.5 ± 3.8 to 60.6 ± 9.4 g/m² (P = 0.0021), and LV posterior wall thickness increased from 3.4 ± 0.4 to 4.4 ± 0.3 mm (P = 0.0048). All patients underwent successful ASO with ductal stent removal and no mortality. Ductal stenting appears to be a safe, effective strategy for LV retraining, and enabling late ASO.