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Eur J Cardiothorac Surg 2007;31:229-235. doi:10.1016/j.ejcts.2006.11.034
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

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

Department of Paediatric Cardiac Surgery, Diana, Princess of Wales Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, United Kingdom

Received 21 August 2006; received in revised form 13 November 2006; accepted 20 November 2006.

^_* Corresponding author. Tel.: +44 121 333 9435; fax: +44 121 333 9441. (Email: william.brawn{at}bch.nhs.uk).

Objective: 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). Methods: 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). Results: 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. Conclusions: 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.

Key Words: Taussig–Bing • Arterial switch • Surgical strategy

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