Porcine Model of the Arterial Switch Operation: Implications for Unique Strategies in the Management of Hypoplastic Left
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ORIGINAL ARTICLE
Porcine Model of the Arterial Switch Operation: Implications for Unique Strategies in the Management of Hypoplastic Left Ventricles Anthony Azakie1 · John P. Carney1 · Matthew T. Lahti1 · Richard W. Bianco1 · Michelle J. Doyle2 · Rajat Kalra2 · Cindy M. Martin2 Received: 15 July 2020 / Accepted: 17 November 2020 © The Author(s) 2020
Abstract There are no reports on the performance of the arterial switch operation (ASO) in a normal heart with normally related great vessels. The objective of this study was to determine whether the ASO could be performed in a healthy animal model. Cardiopulmonary bypass (CPB) and coronary translocation techniques were used to perform ASO in neonatal piglets or a staged ASO with prior main pulmonary artery (PA) banding. Primary ASO was performed in four neonatal piglets. Coronary translocation was effective with angiograms confirming patency. Piglets could not be weaned from CPB due to right ventricle (RV) dysfunction. To improve RV function for the ASO, nine piglets had PA banding. All survived the procedure. Post-banding RV pressure increased from a mean of 20.3 ± 2.2 mmHg to 36.5 ± 7.3 mmHg (p = 0.007). At 58 ± 1 days postbanding, piglets underwent cardiac MRIs revealing RV hypertrophy, and RV pressure overload with mildly reduced RV function. Catheterization confirmed RV systolic pressures of 84.0 ± 6.7 mmHg with LV systolic pressure 83.3 ± 6.7 mmHg (p = 0.43). The remaining five PA banded piglets underwent ASO at 51 ± 0 days post-banding. Three of five were weaned from bypass with patent coronary arteries and adequate RV function. We were able to successfully perform an arterial switch with documented patent coronary arteries on standard anatomy great vessels in a healthy animal model. To our knowledge this is the first time this procedure has been successfully performed. The model may have implications for studying the failing systemic RV, and may support a novel approach for management of borderline, pulsatile left ventricles. Keywords Porcine model · Arterial switch operation · Hypoplastic left heart syndrome · Left ventricle hypoplasia · Right ventricle failure · Heart failure
Introduction The arterial switch operation (ASO) has become the standard of care for D-transposition of the great arteries even in the setting of unusual coronary artery patterns [1–4]. The operation also has indications in the setting of L-transposed
great vessels, as part of the double switch procedure. In both D and L transposed great vessels, the coronaries are usually facing a sinus to which they can be translocated. There are no known reports on the performance of the arterial switch in a normal heart with normally related great vessels. In normal hearts with usual coronary artery
* John P. Carney [email protected]
Rajat Kalra [email protected]
Anthony Azakie [email protected]
Cindy M. Martin [email protected]
Matthew T. Lahti [email protected]
1
Experimental Surgical Services Laboratory, Department of Surgery, University of Minnesota Medical School, Minneapolis,
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