Outcomes and re-interventions after one-stage repair of transposition of great arteries and aortic arch obstruction

Huber, Christoph; Mimic, Branko; Oswal, Nilesh; Sullivan, Ian D.; Kostolny, Martin; Elliott, Martin J.; Leval, Marc de; Tsang, Victor

doi:10.1016/j.ejcts.2010.05.009

Cited by 31 publications

(32 citation statements)

References 13 publications

(17 reference statements)

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“…7 Benefits of single-stage repair include avoiding multiple surgeries, averting the effects of prolonged cyanosis, and preventing the development of AI, congestive heart failure, ventricular hypertrophy, and pulmonary vascular disease. 7,11 To our knowledge, we have identified one of the largest reported cohorts of consecutive patients with Taussig-Bing anomaly to undergo single-stage repair with primary ASO. Our 21-year practice of the currently preferred treatment strategy, as well as our long duration of near-complete follow-up, makes our outcomes data highly applicable to the counseling of today's patients.…”

Section: Discussionmentioning

confidence: 99%

“…3,6,11 In our population, the time to first reintervention was short, and 9 of the 13 patients requiring any reintervention did so within the first postoperative year. Similar to previous studies, [7][8][9][10]14 branch pulmonary stenosis was the most common reason for catheter reintervention in our cohort, and RVOTO was the most common indication for reoperation.…”

Section: Reinterventionmentioning

confidence: 99%

“…The complexity of this malformation is due to a combination of anatomic features, including subaortic RVOTO, 6-8 aortic arch obstruction, 2,3,5-7,9,10 and unusual coronary patterns. 3,5,6,9,11 These and other patient-related factors may contribute to higher complication, mortality, and reintervention rates compared with other forms of transposition of the great arteries. 12 In the past, the outcomes of patients who underwent initial palliation followed by atrial switch were less than satisfactory, 13 and palliation to delay the arterial switch resulted in 5-year event-free survival rates as low as 35%.…”

mentioning

confidence: 99%

“…7,11 To our knowledge, we have identified one of the largest reported cohorts of consecutive patients with Taussig-Bing anomaly to undergo single-stage repair with primary ASO. Our 21-year practice of the currently preferred treatment strategy, as well as our long duration of near-complete follow-up, makes our outcomes data highly applicable to the counseling of today's patients.…”

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confidence: 99%

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

et al. 2013

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The second most common variant of double outlet right ventricle, the anomaly was originally distinguished by a transposed aorta arising entirely from the right ventricle, a pulmonary artery overriding a ventricular septal defect (VSD), side-by-side great vessels, and bilateral subarterial conus with absence of pulmonary-mitral fibrous continuity.1,2 Most surgical series have expanded the definition to include any double outlet right ventricle (with or without pulmonary-mitral continuity) with a subpulmonary VSD, in which left ventricular output flows preferentially to the pulmonary artery. [2][3][4] Despite >30 years of experience with various management strategies, Taussig-Bing anomaly continues to present a considerable surgical challenge. This is largely related to associated anomalies, the most significant of which may be the varying degrees of right ventricular outflow tract and aortic arch obstruction caused by a malaligned ventricular septum. 5 Today, primary arterial switch operation (ASO) with VSD closure is the gold standard for Taussig-Bing anomaly.2,6,7 Significant rates of reintervention, mortality, and neoaortic complications have been demonstrated in studies of this lesion, particularly in patients who had undergone palliative procedures such as pulmonary artery banding before definitive repair. 6,7 Since 1990, single-stage correction with primary ASO has been our institution's practice for all children with Taussig-Bing anomaly. We aimed to describe the long-term outcomes and functional status of patients managed with this surgical approach and to identify factors that predict mortality, reintervention, neoaortic insufficiency (AI), and neoaortic root dilation. Methods Patient SelectionAfter obtaining approval from the Institutional Review Board of Columbia University with a waiver of consent, we retrospectively reviewed our hospital and surgical databases for all admissions diagnosed with transposition of the great arteries or double outlet right ventricle. Patients with Taussig-Bing anomaly were identified as those with a transposed aorta and a pulmonary artery arising in 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 longterm 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 reinte...

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Section: Discussionmentioning

confidence: 99%

Section: Reinterventionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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

et al. 2013

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“…Huber and collaborators report their 10-year experience with one-stage repair of transposition of the great arteries (TGA) associated with aortic arch obstruction (AAO) and (in most cases) ventricular septal defect (VSD) [1]. The results were outstanding in terms of survival (82% overall survival and no mortality in the second half of the experience).…”

mentioning

confidence: 96%