Abstract 12256: Primary Arterial Switch Operation as a Strategy for Total Correction of Taussig-Bing Anomaly: A 21-Year Experience
Background. Studies of the arterial switch operation (ASO) for Taussig-Bing anomaly (TBA) have demonstrated significant rates of reintervention and mortality, particularly in patients with initial palliative surgery to delay complete repair. We aimed to describe the outcomes of our institution's 21-year practice of primary ASO without prior palliation for all patients with TBA, and to identify factors that predict reintervention.
Methods. A retrospective review was performed for all TBA patients from 1990 to 2011. Follow-up was obtained from the primary cardiologist.
Results. Forty-four patients were identified, and all underwent primary ASO. Median age at ASO was 7 days (range 2-192 days), and median weight was 3.2 kg (range 1.9-6.2 kg). Aortic arch obstruction was present in 31 patients (70%), right ventricular outflow tract obstruction (RVOTO) in 9 (20%), and complex coronary anatomy in 21 (48%). Hospital mortality was 6.8% (3 of 44). Of 41 survivors, follow-up was available for 38 (93%) with a mean duration of 8.1 years (range 0.3-21.3 years). Late mortality was 2.3% (1 of 44) in a child with pneumonia 6 months postoperatively. At latest follow-up, all patients were in New York Heart Association functional class I. Freedom from reintervention (by catheterization or surgery) was 71% at 1 year, 61% at 5 years, and 56% at 10 years. Eleven patients underwent 13 catheter reinterventions, including balloon angioplasty or stenting of the pulmonary arteries (n=8) and balloon angioplasty of the aortic arch (n=5). Eight patients underwent 13 reoperations, including pulmonary arterioplasty (n=3), relief of RVOTO (n=5), recoarctation repair (n=2), aortic valve replacement (n=1), aortic aneurysm resection (n=1), and tricuspid valve repair (n=1). In multivariate analysis, factors predicting reintervention included initial aortic arch reconstruction for hypoplasia or interruption (OR 20, p<0.05) and operative weight less than 3.2kg (OR 11, p<0.01).
Conclusions. In one of the largest series to date, it is shown that although reintervention is common, primary correction of TBA can be achieved in virtually all patients with good long-term results. Initial aortic arch reconstruction and lower operative weight are significantly associated with reintervention.
- © 2012 by American Heart Association, Inc.