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Primary Arterial Switch Operation as a Strategy for Total Correction of Taussig-Bing Anomaly: A 21-Year Experience
Study Questions:
What are the long-term outcomes after arterial switch operation (ASO) for Taussig-Bing anomaly?
Methods:
A retrospective review was performed at a single center. Outcome measures included hospital mortality, late mortality, functional class, and need for re-intervention.
Results:
A total of 43 patients with Taussig-Bing anomaly underwent arterial switch between 1990 and 2011. Aortic arch obstruction was present in 70%. Hospital mortality was 7% (n = 3), while late mortality was 2% (n = 1). All patients were described as New York Heart Association functional class I. Freedom from re-intervention (both surgical and transcatheter) was 73% at 1 year, 64% at 5 years, and 60% at 10 years. By multivariate analysis, a preoperative aortic valve annulus Z-score of ≤-2.5 was associated with re-intervention (hazard ratio, 7.66; 95% confidence interval, 1.29-45.6; p = 0.03).
Conclusions:
The authors concluded that primary correction of Taussig-Bing anomaly with ASO can be achieved with low mortality and good long-term outcomes, albeit with a high rate of re-intervention.
Perspective:
Taussig-Bing anomaly is a rare and complex congenital cardiac malformation of double outlet right ventricle with subpulmonary ventricular septal defect, and common associated lesions of right ventricular outflow tract and aortic arch obstruction. The hospital mortality reported in this study is consistent with reported survival for other complex arterial switch procedures. A recent study from the Society of Thoracic Surgeons Congenital Heart Surgery Database reported discharge mortality of 2.2% for ASO for d-transposition of the great arteries, 5.5% for ASO with ventricular septal defect closure, and 7% for ASO with ventricular septal defect closure and arch repair. Although Taussig-Bing anomaly is a complex lesion with a relatively high morbidity and need for re-intervention, long-term outcomes appear to be good.
Keywords: Multivariate Analysis, Hospital Mortality, Morbidity, Transposition of Great Vessels, Confidence Intervals, Double Outlet Right Ventricle, Cardiac Surgical Procedures, New York, Heart Ventricles, Heart Septal Defects
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