• Ann. Thorac. Surg. · Sep 2013

    Comparative Study

    The role of cardiac resynchronization therapy for arterial switch operations complicated by complete heart block.

    • Douglas Y Mah, Mark E Alexander, Puja Banka, Dominic J Abrams, John K Triedman, Edward P Walsh, Francis Fynn-Thompson, John E Mayer, and Frank Cecchin.
    • The Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts 02115, USA. douglas.mah@cardio.chboston.org
    • Ann. Thorac. Surg. 2013 Sep 1;96(3):904-9.

    BackgroundAs mortality in patients with D-loop transposition of the great arteries (D-TGA) has decreased after the arterial switch operation (ASO), the focus has shifted to higher risk groups and outcomes that impact long-term morbidity and mortality, such as left ventricular (LV) dysfunction. We sought to examine the perioperative factors associated with LV dysfunction in patients with D-TGA and ventricular septal defects (VSD) after ASO.MethodsA retrospective study was made of all patients with D-TGA/VSD who underwent ASO/VSD closure from 2001 to 2011. Patients with prematurity, L-looped ventricles, and straddling atrioventricular valves were excluded. The primary endpoint was moderate or severe LV dysfunction measured by echocardiogram 2 months or more after surgery.ResultsA total of 112 patients underwent ASO/VSD closure at a median age of 5 days. Median time of follow-up was 6.5 months, with no mortality noted. Six patients (8%) were noted to have at least moderate LV dysfunction. Risk factors were heart block requiring pacemaker placement (p<0.001) and length of intensive care unit admission (p=0.04). All 6 patients with heart block had an epicardial lead on the right ventricular free wall; 4 had moderate or severe LV dysfunction and underwent upgrade to cardiac resynchronization therapy (CRT); median time from initial pacemaker to CRT was 5 months. With a median follow-up of 5 months after CRT, LV function improved to normal (2 patients) or mild dysfunction (2 patients).ConclusionsLeft ventricular dysfunction after surgical repair for D-TGA/VSD is low, with heart block and pacemaker insertion playing a significant role. The LV function improved after patients were upgraded to a CRT device.Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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