Author + information
- Received November 19, 2018
- Revision received December 20, 2018
- Accepted January 17, 2019
- Published online March 27, 2019.
- Mikael Laredo, MDa,
- Victor Waldmann, MDa,
- Marie A. Chaix, MD, PhDb,
- Réda Ibrahim, MDb,c,
- Benjamin Casteigt, MDa,b,
- Marc Dubuc, MDa,
- Bernard Thibault, MDa,
- Anita W. Asgar, MDa,b,
- Annie Dore, MDb,
- François-Pierre Mongeon, MDb,
- Paul Khairy, MD, PhDa,b and
- Blandine Mondésert, MDa,b,∗ ()
- aDepartment of Medicine, Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- bDepartment of Medicine, Adult Congenital Heart Disease Center, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- cDepartment of Medicine, Interventional Cardiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
- ↵∗Address for correspondence:
Dr. Blandine Mondésert, Institut de Cardiologie de Montréal, 5000 rue Bélanger, H1T1C8 Montréal, Quebec, Canada.
Objectives This study sought to assess the feasibility, safety, and outcomes of a stepwise combined percutaneous approach that includes transvenous lead extraction (TLE) followed by baffle stenting and device reimplantation in patients with D-transposition of the great arteries (D-TGA) and atrial baffle dysfunction.
Background Management of baffle leak or stenosis in patients with D-TGA and atrial switch surgery is challenging in the presence of transvenous cardiac implantable electronic devices. Baffle complications hinder device-related interventions and addressing baffle dysfunction often requires TLE.
Methods All consecutive patients with D-TGA and TLE followed by a percutaneous baffle intervention at the Montreal Heart Institute between 2009 and 2018 were enrolled.
Results Ten patients, median 38.6 years of age (range: 15.2 to 50.6 years), 5 males (50.0%) were included. Procedures were performed for a device-related indication in 5 patients (50.0%) and for baffle dysfunction in 5 patients (50.0%). A total of 19 leads (17 pacing, 2 defibrillation) were targeted, with a median time from implantation of 8.7 (range: 4.3 to 22.1) years. A laser sheath was most frequently required for successful TLE, which was achieved in all patients. Immediate baffle stenting was performed in 9 patients (90.0%) and immediate device reimplantation in 6 (60.0%). During a median follow-up of 3.0 (range: 0.1 to 8.2) years, the only complication was subpulmonary atrioventricular valve damage requiring surgery in 1 patient, 8 months after the procedure.
Conclusions A combined approach with TLE followed by baffle stenting and reimplantation appears to be safe and feasible in D-TGA patients with atrial switch, baffle dysfunction, and transvenous leads.
- baffle leak
- baffle obstruction
- baffle stenting
- congenital heart disease
- Mustard or Senning operation
- transvenous lead extraction
Dr. Khairy is supported by a research chair in electrophysiology and congenital heart disease. Dr. Thibault receives honoraria for presentations to and research support from Abbott and Medtronic. Dr. Mongeon is a member of the advisory board of Actelion. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received November 19, 2018.
- Revision received December 20, 2018.
- Accepted January 17, 2019.
- 2019 American College of Cardiology Foundation
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