Primary Arterial Switch Operation as a Strategy for Total Correction of Taussig–Bing Anomaly

Abstract

Background— Studies of the arterial switch operation for Taussig–Bing anomaly demonstrate significant rates of reintervention and mortality, particularly after initial palliation to delay complete repair. We aimed to describe the long-term outcomes of our 21-year practice of single-stage arterial switch operation for all patients with Taussig–Bing anomaly. Methods and Results— A retrospective study was performed, and 43 patients with Taussig–Bing anomaly were identified between 1990 and 2011. Median age at arterial switch operation was 7 (range, 2–192) days, and median operative weight was 3.2 (1.4–6.2) kg. Aortic arch obstruction was present in 30 patients (70%). Hospital mortality was 7% (n=3). Follow-up was available for 37 hospital survivors at a mean of 8.1 (±6.3) years. Late mortality was 2% (n=1). At follow-up, all patients were in New York Heart Association functional class I. Freedom from transcatheter or surgical reintervention was 73% at 1 year, 64% at 5 years, and 60% at 10 years. Eleven patients underwent 13 catheter reinterventions on the pulmonary arteries (n=8) or aortic arch (n=5). Seven patients underwent 11 reoperations, including relief of right ventricular outflow tract obstruction (n=5), pulmonary arterioplasty (n=3), recoarctation repair (n=2), and tricuspid valve repair (n=1). By multivariate analysis, a preoperative aortic valve annulus z score of ≤−2.5 was associated with reintervention (hazard ratio, 7.66 [95% confidence interval, 1.29–45.6], P =0.03). Conclusions— Although reintervention is common, primary correction of Taussig–Bing anomaly with arterial switch operation can be achieved in all patients with low mortality and good long-term outcomes.