New Enhanced Left Ventricular Training in Corrected Transposition of the Great Arteries by Increasing After- And Preload

Purpose: Patients with corrected transposition of the great arteries (ccTGA) beyond the newborn age need a left ventricular (LV) training to undergo a double switch operation (DS) (atrial plus arterial switch operation). A new approach with pulmonary arterial banding (PAB) and atrioseptectomy to increase pre- and afterload is prospectively evaluated in regards of effectivity, numbers of re-operations necessary and the outcome of DS.

Method: We report on six consecutive patients with ccTGA to be trained for DS using this enhanced LV training (eLVT). Five patients had conventional PAB before, but did not reach a sufficient gradient across the banding. All six patients underwent eLVT as the last procedure to reach DS.

Results: Five of six patients underwent successful DS at in mean 1.2 years after enhanced LV training (eLVT). The postoperative period was short and uneventful in all patients with a total ventilation time of 24 hours, stay on ICU of 3 days and dismissal from the clinic after 11 days (median values). Over the median follow up period of 1.5 years (7.2 patient’ years) unrestricted cardiac function and biventricular circulation, no additional arrhythmic episodes and regression of tricuspid valve regurgitations were observed.

Conclusion: With the eLVT re-PAB operations can be reduced and DS performed at low risk and short periods on intensive care units. If it is equally efficient in patients older than 12 years, has to remain open. Long term follow-up is still needed and results from other centers are essential to underline the benefit of this procedure.