Late outcomes after arterial switch operation for Taussig-Bing anomaly

Abstract

In the largest series to date of ASO for TBA, mortality is confined to the first postoperative year, and related to coronary artery pattern. Beyond the first year, needed reinterventions are frequent, but with sustained functional status and no mortality over >10 years follow-up. Aortic arch obstruction is the main predictor for reintervention. Despite a significant rate of early events, favorable long-term outcomes argue for use of the ASO in TBA patients.

Clinical outcomes of primary arterial switch operation in treatment of Taussig-Bing anomaly

“…[6,8] In our study, the rate of preoperative subaortic stenosis was coincidentally lower (5%). Therefore, none of the patients required right ventricular outflow tract reconstruction at the initial repair.…”

“…[6,7] Primary repair has the advantage of avoiding multiple surgeries and also, with primary palliation, patients are exposed to a longer period of cyanosis and have the risk of developing heart failure, pulmonary vascular disease, and aortic insufficiency. [8] In cases with complex anatomy, prematurity, and preoperative complications Schwarz et al [7] proposed that a two-stage approach can still be preferable.…”

“…[7] Recent series equivocally advocate the repair of the arch pathology on the same stage during the arterial switch operation. [6,7,10] The technique of aortic arch repair vary among different clinics and include end-toside repair, [7] integrating neoaortic stump into the arch anastomosis or aortic relocation, [10] and routine patch augmentation. [6] Our cohort is heterogeneous regarding the technique of the arch repair; mainly extended endto-end anastomosis and patch augmentation were the techniques applied based on the surgeons' preference.…”

“…Although our cohort showed an increased risk in patients with an arch pathology, in the recent cohorts, it has been shown that additional arch pathology can be addressed without an increased risk of mortality or reoperations. [6,9] Therefore, single-stage approach still seems to be preferable in patients with accompanying arch obstruction.…”

“…[1] Although various alternative repair strategies have been developed through the years, [2][3][4][5] the closure of the ventricular septal defects (VSDs) tunneling the left ventricular outflow tract to the pulmonary valve followed by arterial switch operation was accepted as the method of choice, particularly in the past decade. [6][7][8][9][10] One of the concerns regarding the management has been the high coincidence of TaussigBing anomaly with aortic arch obstruction which was spotted early in the surgical experience. [11] The recent literature has addressed into the debate on whether the arch obstruction can be managed on the same stage as the Taussig-Bing repair or whether a staged approach is more suitable in selected cases.…”