Results Of Arterial Switch Operation Research Articles

Outcomes of Arterial Switch Operation With Aortic Arch Reconstruction

BackgroundThis study investigated the outcomes and factors associated with reintervention or development of significant pulmonary stenosis (PS) after repair of transposition of the great arteries (TGA) or Taussig-Bing anomaly (TBA) with aortic arch obstruction. MethodsA total of 51 patients with TGA or TBA who underwent an arterial switch operation and aortic arch reconstruction between 2004 and 2020 were included. The outcomes of interest were all-cause death, including heart transplantation, all-cause reintervention, right-sided reintervention, and development of significant PS. ResultsThe median age and body weight at repair were 9 days and 3.2 kg, respectively. Forty-nine patients (96.1%) underwent 1-stage repair. A total of 28 patients (54.9%) had TBA, and 8 patients (15.7%) had interrupted aortic arch. There were 5 early deaths (9.8%) and 2 late deaths during a median follow-up duration of 59 months. The transplant-free survival rate 10 years after repair was 82.6%. A total of 21 reinterventions were required in 10 patients. The significant PS–free survival rate 10 years after repair was 68.8%. In univariable analysis, a higher ratio of the diameter of the main pulmonary artery to the ascending aorta was associated with all-cause reintervention (P = .007) and right-sided reintervention (P = .002). A smaller aortic annulus z-score at the pulmonary position was associated with the development of significant PS (P = .049). ConclusionsThe rates of overall mortality and reintervention after repair were not negligible. A higher degree of size discrepancy between the 2 great arteries was associated with all-cause or right-sided reintervention. A smaller aortic annulus z-score at the pulmonary position was associated with the development of significant PS.

Impact of Coronary Artery Anatomy in Arterial Switch Operation: In-hospital and Post-discharge Outcomes.

The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation (ASO) is currently controversial, and the risk factors for this operation may change in more complicated patients. This study aimed to investigate the influence of coronary artery anomalies on the in-hospital and post-discharge outcomes of ASO in patients with transposition of the great arteries (TGA) and Taussig-Bing anomaly (TBA). We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019. The median age at operation was 33 [interquartile range (IQR): 20-71] days. Median follow-up time was 7.2 years (IQR: 4.0-10.3 years). Coronary anomalies were present in 86 patients (41.7%), with 9 (4.4%) of them having a single coronary artery. Additional coronary features included intramural courses in 5 (2.4%) patients, ostial stenosis in 1 (0.5%) patient, and accessory coronary artery orifices in 5 (2.4%) patients. There were 32 (15.5%) in-hospital deaths and 8 (4.6%) post-discharge deaths, yielding an overall survival of 81.3%, 80.7% and 79.9% at 1, 5 and 10 years, respectively. Mortality due to ASO has been drastically decreased since 2013. Patients with a single coronary artery had higher rate of in-hospital mortality, but this finding was not statistically significant. The earlier surgical era (OR: 2.756) and a longer cardiopulmonary bypass time (OR: 2.336) were significantly associated with in-hospital mortality, while coronary patterns were not. An intramural coronary artery (HR: 10.034) and a patient age of older than 1 year at the time of ASO (HR: 9.706) were independent predictors of post-discharge mortality. ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation. However, intramural coronary artery is an independent risk factor for post-discharge mortality. Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.

Results of the arterial switch operation for Taussig-Bing variants in the setting of a lower-middle income country: A single-institution experience.

This study was conducted to evaluate the surgical results of the arterial switch operation for Taussig-Bing variants, at a single institution in a lower-middle income country. Between June 2010 and December 2018, all consecutive patients diagnosed with Taussig-Bing variants who underwent the arterial switch operation and ventricular septal defect closure were included in the study. A total of 72 patients of Taussig-Bing variants underwent arterial switch operation and ventricular septal defect closure. There were 10 early deaths (13.9%) and 2 late deaths (2.8%). Intraoperative ventricular septal defect enlargement (hazard ratio [HR] 7.23, 95% confidence interval [CI] 3.1294-16.7167; p < .001), secondary aortic cross-clamping (HR 28.38, 95% CI 4.8427-166.3484; p < .001), postoperative pneumonia (HR 5.64, 95% CI 1.2724-24.9917; p = .023), and postoperative sepsis (HR 5.28, 95% CI 1.3512-20.6553; p = .017) were risk factors for overall mortality by competing risk analysis. Sixty patients (83.3%) required septoparietal trabeculation division/resection during the arterial switch operation in an attempt to avoid right ventricular outflow tract obstruction. The reoperation rate for right ventricular outflow tract obstruction at last follow up was 6% (three patients). The estimated freedom from reoperation for right ventricular outflow tract obstruction at 1, 5, and 9 years was 98.3%, 91.9%, and 91.9%, respectively. The results of arterial switch operation for Taussig-Bing variants were satisfactory in the operative setting of a lower-middle income country, and performing extensive septoparietal trabeculation division might reduce the reintervention rate for right ventricular outflow tract obstruction in these patients.

Outcomes of arterial switch operation in patients with intramural coronary arteries at National Children’s Hospital

Objectives: To evaluate the outcomes of arterial switch operation (ASO) in a subgroup of patients who had intramural coronary arteries at National Children’s Hospital. Methods: From 2010 to 2016, 304 patients underwent ASO at National Children’s Hospital. In which, eighteen (5.9%) had intramural coronary arteries. These medical records of these patients were collected and retrospectively reviewed. Results: There were 10 male and 8 female in this group of patients. Patients with intramural coronary arteries had transposition of the great arteries (83.3%, n = 15) or Taussig - Bing anomaly (16.7%, n = 3). At the time of surgery, mean age was 69.5 ± 81.5 [11 - 321] days and mean weight was 3.9 ± 1.1 [2.5 - 6.3] kg. Mean bypass time and mean aortic cross - clamped time were 235 ± 90 [168 - 564] minutes and 149 ± 29 [100 - 255] minutes respectively. There were 3 deaths (16.7%): two hospital deaths (at 6 days and 26 days after ASO), one death after discharge (2 months later). One patient lost follow - up. Other 14 patients are in a good health status after discharge and free of re - intervention or reoperation related to the total correction with the mean follow - up time of 68.0 ± 38.5 [2 - 113] months. Conclusions: Intramural coronary arteries remain a rare coronary anatomic variant following ASO. The outcomes of ASO in this subgroup of patients is quite favorable. Long - term follow - up is necessary.

Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study

BackgroundArterial switch operation (ASO) is today the first-choice surgical treatment for patients with transposition of the great arteries. Long-term outcome data still remain scarce. Moreover, the course of these patients is not uneventful. Therefore, we wanted to evaluate long-term outcome and determine on which variables to focus during follow-up. MethodsClinical records of 318 patients who underwent ASO between October 1981 and July 2018 were reviewed. Perioperative, post-operative, and interventional data were collected to determine mortality and the need for re-intervention. Descriptive statistics and Kaplan-Meier survival analysis were performed. ResultsMean follow-up time was 11.1 SD 8.5 years (range 0–35) with a mean age of 12.5 SD 9.0 years (range 0–37) at latest follow-up. In-hospital mortality was 7.5% and overall survival 90.9% for a maximum follow-up time of 35 years. Causes of early mortality were cardiogenic shock, severe pulmonary hypertension, septic shock and multiple organ failure. Causes of late mortality were cardiogenic shock, severe pulmonary hypertension, pacemaker lead fracture and fire death. Re-intervention free survival at 5-year was 91.6%, at 10-year 90.7%, at 20-year 79.2%. For all survivors, the most frequent sequelae after ASO were pulmonary artery stenosis (80.9%), of which 13.5% needed an intervention. The threshold for intervening on lesions at the level of the pulmonary artery bifurcation was higher and the percutaneous re-intervention rate was higher for non-bifurcation lesions. ConclusionsDespite a relatively high peri-operative mortality, TGA patients have an excellent overall long-term survival. However, a large proportion of patients requires re-interventions, mainly for pulmonary artery stenosis.

Long Term Outcomes of Arterial Switch Operation At The Transposition of the Great Arteries

Long Term Outcomes of Arterial Switch Operation At The Transposition of the Great Arteries

Outcomes of arterial switch operation for Taussig-Bing anomaly versus transposition of great arteries and ventricular septal defect.

This study aims to present the outcomes of arterial switch operation for Taussig-Bing anomaly versus transposition of the great arteries and ventricular septal defect. Between November 2010 and December 2016, a total of 100 consecutive arterial switch operations in 42 pediatric patients (25 males, 17 females; median age 17 days; range, 2 to 210 days) were performed in two centers. Among them, 42 patients had associated ventricular septal defect and were diagnosed with Taussig-Bing anomaly (n=15) or transposition of the great arteries and ventricular septal defect (n=27). Aortic arch anomalies were present in six patients (40%) with Taussig-Bing anomaly and two patients (7.4%) with transposition of the great arteries and ventricular septal defect (p=0.016). Coronary anomaly was observed in five (33.3%) and six (22.2%) patients, respectively. All patient had a large defect (multiple n=4), except for eight patients who had moderate defect in the transposition of the great arteries group. Early mortality was 13.3% in the Taussig-Bing anomaly group and 7.4% in the other group. Extracorporeal membrane oxygenation support was needed in three patients. Delayed sternal closure was used in most of the patients (92.9%). The median length of intensive care unit and hospital stays were similar between the groups. The median follow-up was 16 (range, 1 to 50) months. Two patients including one planned (debanding and multiple defect closure) and one unplanned (residual defect closure) were reoperated. Three patients needed aortic balloon angioplasty due to recoarctation and one patient underwent pulmonary balloon angioplasty. Overall reintervention rate was 18.4%. Although the incidence of aortic arch and coronary anomalies were higher in patients with Taussig-Bing anomaly, early and mid-term results were similar. Based on these results, primary arterial switch operation seems to be successfully performed for both pathologies.

Early Outcomes of Arterial Switch Operation Performed at a New Pediatric Cardiology Center in Mumbai

Introduction: The transposition of great arteries (TGA) is one of the main causes of neonatal or early infancy open heart surgeries in pediatric cardiology. The ASO is preferred over the Atrial switch when suitable as the left ventricle remains the systemic ventricle and there are fewer incidences of postoperative arrhythmias. Method: It’s a retrospective review of the early surgical outcomes of arterial switch operation performed at the department of pediatric cardiology at Wockhardt Hospital, Mumbai Central, Mumbai from August 2014 to August 2017. Results: During the specified period, a total of 22 children were admitted to the hospital for ASO for TGA. The average age of the patient was 78 days. The mean weight of the children was 3.35 kg and height was 52.5 cm. Discussion: The early outcome of arterial switch operation at our center is as good as the other well-established centers. The surgical outcome of ASO remained consistent over the last two and a half year. The policy of our institution is to optimize the patients prior to the surgery, may need BAS if the children are of TGA with intact ventricular septum with restricted atrial level shunt group. Conclusion: The review shows the early results of postoperative cases of arterial switch operation from a new center are as encouraging as from the other high volume centers.

Результаты выполнения операции артериального переключения при аномалии Тауссиг–Бинга

Результаты выполнения операции артериального переключения при аномалии Тауссиг–Бинга

Predictors of early outcome of arterial switch operation in patients with D-TGA

BackgroundThe arterial switch operation (ASO) has become the procedure of choice for the transposition of great arteries (TGA) and double outlet right ventricle (DORV) Taussig – Bing anomaly. The improvement in diagnosis, surgical techniques, and peri-operative management resulted in improvement in mortality and morbidity. The objective of this study was to evaluate the preoperative demographic, morphological and operative variables that affect the early outcome of the arterial switch procedure. MethodsThis is a retrospective study of 85 patients who underwent ASO in children's cardiovascular program (Deutsches Herzzentrum, Berlin) between august 2012 and October 2015. It included all patients underwent ASO for D-TGA or DORV. Preoperative, operative and postoperative variable were studied and analyzed for their correlation to unfavorable early postoperative outcome [mortality or high morbidity such as need for extra-corporeal membrane oxygenation (ECMO), occurrence of coronary events and reoperation or catheter intervention]. ResultsThere were 3 (3,5%) early deaths in our study; 2 due to coronary ischemic events and one due to low cardiac output. Five coronary events and 17 early reoperations or catheter interventions were recorded. Several risk factors were associated with unfavorable outcome as low birth weight patients (P-value = 0.03), preoperative corticosteroid intake (P-value = 0,046), intramural course of coronary arteries (P-value = 0.04), but retropulmonary course and mono-coronary ostium had no correlation to unfavorable outcome. There was no correlation between having simultaneous operative procedure and the unfavorable outcome (P-value = 0.9). The predictors of unfavourable outcome included prolonged ischemic time (P-value = 0.000), prolonged cardiopulmonary bypass time, prolongation of the ventilation time and increasing amount of postoperative bleeding (P-value = 0,000). The increase in the ischemic time had a strong statistical correlation with the increased inotropic support in the postoperative period (P-value = 0.002). ConclusionsASO can be performed without excess mortality. Simultaneous aortic arch repair can be done with no extra mortality. Prematurity, low birth weight, Taussig-Bing anomaly, intramural coronary artery course and some other coronary abnormalities, aortic cross clamp time and bypass time were risk factors for unfavourable outcome.

RESULTS OF APPLICATION OF THE MODIFIED “CLOSED” METHOD OF REIMPLANTATION OF CORONARY ARTERIES IN ARTERIAL SWITCH OPERATION

Introduction. Currently, the standard surgical treatment of patients with transposition of the great arteries (TGA) is an arterial switch operation in the neonatal period. Reimplantation of the coronary arteries during the operation is the key to success. Therefore, constant search for new and modification of known techniques are ongoing. The goal of our work was to present the results of arterial switch operation using a modified closed technique for reimplantation of the coronary arteries. Materials and Methods. During the period from 2011 to December, 2016, in Research Institute — Regional Clinical Hospital No. 1 n.a. Prof. S.V. Ochapovsky, 63 operations of arterial switch using modified closed technique reimplantation of the coronary arteries were performed. The average age at operation was 4.77±2.54 days; the average weight was 3.33±0.35 kg. On average, the operation was performed on the 5th day after birth. Diagnoses: Patients with simple TGA (n=49); patients with TMA and ventricular septal defect (VSD) (n=11); patients with TGS and VSD (including one patient with multiple defects) who had obstruction of the aortic arch (n=3). The study showed that the only limitation of the modified closed method for reimplantation of the coronary arteries was an intramural course of the coronary arteries. 58 patients (92%) received alprostadil infusion; 22 patients (34.9%) received balloon atrioseptostomy (Rashkind procedure). Results. The hospital mortality rate was 7.93% (5 patients). The mortality rates were 6.1% (3 patients in the 49 operations) in the group with simple TGA and 18.1% (2/11 patients) in patients with VSD. No fatal outcomes occurred among patients with an anomaly of the aortic arc. The causes of mortality were the multiple organ failure (2 patients) and sepsis in the presence of necrotizing enterocolitis (3 patients). Discussion. Arterial switch operation at the present stage of pediatric cardiac surgery development is the operation of choice for patients with the transposition of the great vessels with feasible biventricular correction. Mortality was primarily due to the initial severity of patient condition and concomitant infection. Closed technique for reimplantation can improve the control of bleeding by reducing the number of weak spots of the aortic anastomosis (weak spots in U-shaped or trap door anastomoses are the areas of tying the yarns to create neoaortic root) and by generating the neoaortic sinotubular junction which reduces the risk of aortic insufficiency. Analysis of literature data and our own observations suggest that the closed technique and its modifications reduce the likelihood of coronary ischemia. Reimplantation of the coronary arteries by the closed procedure is feasible in case of any coronary anatomy except intramural coronary artery. Moreover, our modification allows to reduce the time of myocardial ischemia (due to the absence of a stage for aortic clamp removal for the filling neoaorta with blood) and, consequently, the duration of cardiopulmonary bypass and the time of entire procedure.

Primary, single-stage arterial switch operations at a newly-established, comprehensive congenital cardiac center performed in the neonatal age and beyond

Outcome of arterial switch operation for transposition of the great arteries with/without ventricular septal defect is a service key-performance-indicator. The aim of the authors was to assess patient characteristics and parameters in the perioperative course. In the setting of a newly-established, comprehensive tertiary-care center, primary complete repair was performed including associated anomalies, e.g. transverse arch repairs. Patients with d-transposition were grouped according to coexistence of ventricular septal defect. 118 arterial switch operations were performed between 2007 and 2014 with 96.62% survival (114/118). Ventricular septal defect and repair of associated anomalies did not yield worse outcome. Left ventricular re-training with late presentation necessitated mechanical circulatory support for 4.5±1.5 days. D-transposition is suitable for standardization of clinical algorithm and surgical technique. Quality standards contribute to excellent outcomes, minimize complications, and serve as blueprint for other neonatal open-heart procedures. Availability of mechanical circulatory support is key for single-stage left ventricular re-training beyond the neonatal period.

Midterm Outcome of Primary Arterial Switch Operation Beyond Six Weeks of Life in Children With Transposition of Great Arteries and Intact Ventricular Septum

We have previously reported our experience in primary arterial switch operation (ASO) in children more than six weeks with transposition of great arteries and intact ventricular septum (TGA/IVS). The upper age limit for performing an ASO in these children is not yet settled and reports regarding outcome of ASO in these children are few. In this prospective observational study, we report the midterm results of children with TGA-IVS older than six weeks undergoing primary ASO. A total of 109 children aged more than 6 weeks with median age of 60 days (range 42-3,000 days), with regressed left ventricle underwent primary ASO. Extracorporeal membrane oxygenation was used in 20% (22 of 109) of them; 90.8% (99 of 109) of children who survived were prospectively followed, with a mean follow-up of 28 months (range 18-84 months). Two late deaths occurred, and survival in the remainder was estimated to be 98% at seven years. The incidence of aortic regurgitation (AR) was found to have a decreasing trend with freedom from AR approaching 100% by 34 months. The left ventricular shape and function returned to normal within one to three months following surgery. None of these children had any rhythm disturbances or evidence of myocardial ischemia. Primary ASO can be safely performed in children with regressed ventricle, irrespective of age with encouraging results. The midterm results of these children are comparable in terms of survival and freedom from complications associated with preserved ventricle.

Midterm Results of Arterial Switch Operation in Older Patients With Severe Pulmonary Hypertension

It is widely accepted that patients older than 6 months with dextrotransposition of the great arteries and nonrestrictive ventricular septal defect or Taussig-Bing anomaly and severe pulmonary hypertension usually are not candidates for an arterial switch operation or even repair. This study aimed to evaluate the midterm results of the arterial switch operation in these selected patients. The records of 86 patients older than 6 months with dextrotransposition of the great arteries and nonrestrictive ventricular septal defect or Taussig-Bing anomaly and severe pulmonary hypertension undergoing the arterial switch operation at our institution from 2000 to 2008 were reviewed retrospectively. Eighty survivors were followed. There were 6 hospital deaths (7.0%, 95% confidence interval, 1.6% to 12.4%). From 2006 to 2008, 46 were operated without deaths occurring. The median duration of follow-up was 42 months. Two late deaths occurred. Latest follow-up data showed that 2.8% of survivors were in New York Heart Association class II and 97.2% in class I. Midterm results of the arterial switch operation for patients older than 6 months with dextrotransposition of the great arteries and nonrestrictive ventricular septal defect or Taussig-Bing anomaly and severe pulmonary hypertension are excellent in the current era.

Influence of coronary artery variation on the outcome of arterial switch operation

To investigate the influence of coronary artery variation on the outcome of arterial switch operation for transposition of great arteries. Among 280 patients undergoing arterial switch operations at our hospital from 2001 to 2008, 73 (26.1%) had concurrent coronary arteries variation (54 males and 19 females; median age: 0.6 ± 1.1 years old; mean body weight: 5.8 ± 2.6 kg). Of these 73 patients (variant group), 21 cases had transposition of great arteries with a ventricular septal defect and 30 cases with an intact ventricular septum. The other 22 cases were of Taussig-Bing anomalies. Another 207 cases had usual coronary arteries (usual group). Coronary artery transfer was achieved by implantation of buttons to the previously anastomosed neo-aorta. There were 29 early death (10.4%) including 12 cases (16.4%) in variant group and 17 cases (8.21%) in usual group (P < 0.05). Mean cardiopulmonary bypass and cross-clamp durations were 229 ± 84 and 146 ± 48 min in variant group while 206 ± 59 and 137 ± 40 min in usual group (P < 0.05). Six cases were confirmed intra-operatively as coronary compression or obstruction. Complications included infection (n = 11), low output syndrome (n = 7), diaphragm paralysis (n = 3), pericardial effusion (n = 2) and atrioventricular block (n = 2). Coronary artery variation increases the operative difficulty and influences the outcome. The operative proficiency may decrease the mortality.

Intramural coronary arteries and outcome of neonatal arterial switch operation

To evaluate the impact of coronary patterns with intramural arteries on the outcome of arterial switch operation (ASO) in neonates with transposition of the great arteries (TGA). Between 1987 and 2008, 919 neonates underwent ASO for TGA. Forty-six (5.0%) had intramural coronary arteries. Intramural course involved the left main coronary artery in 28 of the 46 cases (61%), the left anterior descending artery in 12 patients (26%), the right coronary artery in three and both right and left coronary arteries in three cases. Various techniques were used to manage the coronary arteries: ASO without coronary relocation in one, ASO with coronary transfer as a single coronary button in nine and ASO with coronary transfer as two separate buttons in 36 patients (additional pericardial patches were implanted to orientate the coronary button in nine cases or enlarge the coronary ostium in three cases). The intramural course was unroofed in most cases (after 1995). There were 13 deaths (28%): two intra-operative, nine before discharge from the hospital and two after discharge; during the same period, overall mortality in the 873 neonates with other coronary patterns was 3.9%. Actuarial survival at 10 years was 71 + or - 7%. Most deaths (11/13, i.e., 85%) were related to coronary complications. No time-trend effect was noted regarding mortality. Non-fatal coronary lesions were detected in eight patients (three with clinical evidence of myocardial infarction and five without). Five patients underwent re-operation for coronary revascularisation. Actuarial freedom from coronary events at 10 years was 46 + or - 10%. After a mean follow-up of 8.3 + or - 4.8 years, left ventricular function was normal in 97% of the survivors; minor ischaemic sequelae were present in two patients. Coronary patterns with intramural arteries remain associated with high coronary mortality and morbidity following neonatal ASO, even in the current era. The association of slit-like deformation of the ostium, stenosis of the intramural course and abnormal angle of take-off might explain the difficulty in coronary transfer. The technique of coronary transfer should be individually adapted to each anatomical situation. The place of patch ostioplasty of the intramural artery remains to be determined.

Predictors of Outcome of Arterial Switch Operation for Complex D-Transposition

Predictors of Outcome of Arterial Switch Operation for Complex D-Transposition

Predictors of Outcome of Arterial Switch Operation for Complex D-Transposition

Overall mortality and reoperation risk for the arterial switch operation (ASO) for D-transposition of the great arteries (D-TGA) is low. D-TGA with ventricular septal defect (VSD) and aortic arch obstruction (AAO) is a higher risk subgroup in which we sought risk factors for mortality and reoperation after ASO. Echocardiograms of 74 patients who underwent ASO, VSD, and arch repair for D-TGA, VSD and AAO were reviewed; the reoperation analysis considered the 65 survivors. Pre-ASO clinical and anatomic characteristics were compared between survivors and nonsurvivors; patients who required (R) and did not require (NR) reoperation. Distal transverse aortic arch (TrAo) z score equal to -2.5 or less, triscuspid valve z score less than 0, repaired muscular VSD, and circulatory arrest time were significant predictors of mortality. When stratified for circulatory arrest time below 60 minutes, small distal transverse aortic arch and tricuspid valve remained significant predictors of mortality. Mean aortic annulus size was smaller in R than NR (p = 0.048). Left coronary artery arising posteriorly was associated with a reoperation hazard ratio of 5.2 (p = 0.022). Preoperative anatomy was associated with death and reoperation post-ASO. Small TrAo and TV were risk factors for mortality in univariate analysis, and remained significant in the subset of patients with short circulatory arrest times, suggesting that even when controlling for technical factors, anatomic risk factors predict mortality. Small aortic annulus and posterior left circumflex artery origin were associated with reoperation. Patients with D-TGA, VSD, and AAO constitute a higher risk group, which includes patients who may be marginal candidates for two-ventricle repair.

Surgical Results of Arterial Switch Operation for Taussig-Bing Anomaly: Is Position of the Great Arteries a Risk Factor?

A variety of definitive operations have been used to manage patients with double-outlet right ventricle and subpulmonary ventricular septal defect (Taussig-Bing anomaly). This study identifies the impact of the position of the great arteries and use of a staged surgical approach on the outcome after the arterial switch operation in children with Taussig-Bing anomaly. From 1986 through July 2005, 34 patients with Taussig-Bing anomaly underwent the arterial switch operation. The median age at operation was 21 days. Based on position of the great arteries, patients were divided into group I (side by side; n = 16) and group II (anteroposterior; n = 18). Aortic arch obstruction was present in 18 patients (53%), of whom 16 had prior repair with aortic arch reconstruction. Abnormal coronary artery patterns were present in 9 patients (27%). There were 4 early deaths and 1 late death (3 from group I and 2 from group II). The actuarial survival rate was 85% at 15 years (81% in group I and 89% in group II). Right ventricular outflow tract obstruction (mean gradient, 46.0 +/- 5.5 mm Hg) developed in 5 cases (2 from group I and 3 from group II). One patient underwent reoperation for residual aortic arch obstruction. Freedom from reoperation was 80% at 15 years, and thereafter 85% in group I and 75% in group II. Statistical analysis of potential risk factors revealed no significant identifiers for death or need for reoperation between groups. The arterial switch operation remains our preferred choice of treatment for children with Taussig-Bing anomaly. The position of the great arteries has no effect on postoperative morbidity and mortality. In the presence of aortic arch obstruction, staged arch reconstruction followed soon thereafter by early intracardiac repair has yielded excellent outcomes in our experience.

Arterial switch operation in patients with Taussig–Bing anomaly — influence of staged repair and coronary anatomy on outcome☆

This study evaluated the results of arterial switch operation and closure of ventricular defects (ASO+VSDc) for double outlet right ventricle with sub-pulmonary ventricular septal defect (Taussig-Bing anomaly). Between 1988 and 2003, 33 patients (25 male, 76%) with Taussig-Bing anomaly underwent ASO+VSDc (median age 39 days, 1 day-2.1 years). The relationship of the great arteries was antero-posterior (Group I, n=19) or side-by-side (Group II, n=14). Coronary anatomy (Yacoub's classification) was exclusively type A or D in Group I and predominantly type D or E in Group II (64%). Incidence of sub-aortic obstruction and aortic arch obstruction was similar in Group I and II (37% vs 57%, p=0.25 and 84% vs 79%, p=0.98, respectively). Twenty-five patients (76%) had one-stage total correction. Risk factors were analysed using multivariable analysis. Follow-up was complete (median interval of 6.2 years; range, 0.6-15.2 years). There were three early (9%) and one late death. Actuarial survival was 88+/-6% at 1 and 10 years. There were two early and four late re-operations. Freedom from re-operation was 90+/-5% and 75+/-9% at 1 and 10 years. Four patients required cardiological re-interventions. Freedom from re-intervention at 5 and 10 years was 79+/-9%. On multivariable analysis, complex coronary anatomy (type B and C) was a risk for early mortality (p<0.001) but all other anatomical variables and staged strategy did not influence early or actuarial survival. The ASO+VSDc approach can be applied to Taussig-Bing anomaly with acceptable mortality and morbidity and it is the procedure of choice at our institution. Anatomical variables did not influence outcomes with this strategy. A staged strategy is still appropriate in complex cases.