Outcomes of the Arterial Switch Operation in Patients With Taussig-Bing Anomaly

Background. The arterial switch operation (ASO) is associated with poorer outcomes in patients with Taussig-Bing anomaly (TBA) compared with transposition of the great arteries (TGA). We describe the outcomes after ASO in patients with TBA at a single institution. Methods. Between 1983 and 2009, 57 patients with TBA underwent the ASO at the Royal Children's Hospital in Melbourne. Results. Hospital mortality was 5.3% (3 of 57). Larger weight at operation (p = 0.015), pulmonary artery banding prior to ASO (p = 0.049) and concurrent pulmonary artery banding (p = 0.049) were risk factors of early death. Actuarial survival was 94% at 15 years. Follow-up was 84% complete with a mean follow-up of 9.8 +/- 6.7 years (range, 6 days to 19.1 years). There was no late mortality. Reintervention was required in 24.4% (11 of 45). Longer cross-clamp time (p = 0.027) was a risk factor for reintervention. Freedom from reintervention was 75.3% at 15 years. After ASO, 2.2% (1 of 45) presented with sub-neopulmonary obstruction and 13.3% (6 of 45) had moderate or more neoaortic insufficiency (neo-AI). Surgery prior to ASO was a risk factor for sub-neopulmonary obstruction (p = 0.049) and moderate or more neo-AI (p = 0.016). Freedom from moderate or more neo-AI was 91.1% at 10 years. Conclusions. Early mortality has improved over time with no mortality occurring in the last decade. Although patients are doing well on late follow-up, many patients require reintervention and show progression of neo-AI. Close long-term follow-up is warranted as patients are likely to require further reintervention in the second decade after TBA repair. (Ann Thorac Surg 2011;92:673-9) (C) 2011 by The Society of Thoracic Surgeons PEDIATRIC CARDIAC