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Eur J Cardiothorac Surg 2007;31:873-878. doi:10.1016/j.ejcts.2007.02.004
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Right ventricular outflow tract obstruction after arterial switch operation for the Taussig–Bing heart

^a Department of Pediatric Thoracic and Cardiovascular Surgery, Congenital Cardiac Center ("Deutsches Kinderherzzentrum"), Sankt Augustin, Germany
^b Department of Anesthesiology and Critical Care Medicine, Congenital Cardiac Center ("Deutsches Kinderherzzentrum"), Sankt Augustin, Germany

Received 6 September 2006; received in revised form 26 January 2007; accepted 2 February 2007.

^_* Corresponding author. Address: Deutsches Kinderherzzentrum, Asklepios Klinik, Arnold-Janssen-Strasse 29, 53757 Sankt Augustin, Germany. Tel.: +49 2241 249601; fax: +49 2241 249602. (Email: n.sinzobahamvya{at}asklepios.com).

Objective: Incidence of right ventricular outflow tract obstruction (RVOTO) may be suspected to be higher after arterial switch operation (ASO) for Taussig–Bing heart than after ASO for transposition of the great arteries (TGA), as Taussig–Bing anomaly is frequently associated with aortic arch obstruction and subvalvular aortic stenosis. We evaluated the risk to develop RVOTO after ASO for Taussig–Bing heart. Methods: The 34 Taussig–Bing cases who underwent ASO from 1984 to 2005 were reviewed. RVOTO was defined as peak echo-gradient 30 mmHg across right ventricular outflow tract. Kaplan–Meier method was used to estimate time-related events. Results: Subaortic stenosis was resected in 25 patients, 20 of whom (80%: 20/25) were discharged from hospital free from RVOTO. There was one early death: 2.9% mortality. Three patients died late. Actuarial survival was 85.1% ± 7.0% from 54 month onwards. Eleven survivors (36.7%: 11/30) experienced postoperative RVOTO. Obstruction was seen in 82% (9/11) of cases at subvalvular and/or valvular level. Surgery (n = 4) or percutaneous intervention (n = 2) was required in six patients. Patients discharged from hospital with RVOTO (n = 8) were more likely to undergo reintervention for RVOTO (p = 0.026). Freedom from reintervention for RVOTO decreased rapidly in the first two years to 86.5 ± 6.3%, slowly thereafter (80.4 ± 8.4% at year 7) and stabilized at 70.3 ± 11.9% from year 11 on. Risk for RVOTO occurrence was 23.5 ± 7.3% early after repair and progressively increased to level out at 53.6 ± 11% at year 11. Patients who underwent subaortic resection were more likely (p = 0.023) to be free from RVOTO occurrence or development. In the period under review, for patients who underwent ASO for simple (n = 355) and complex (n = 92) TGA, reoperation rate for neopulmonary stenosis was 0.3% (1/355) and 5.4% (5/92), respectively, to be compared to 11.8% (4/34) RVOTO rate of reoperation for Taussig–Bing heart in this study. Conclusions: Postoperative right-sided obstruction occurs more frequently after ASO repair of Taussig–Bing heart than after TGA arterial switching, leading to higher reintervention rate. Resection of the commonly associated subaortic stenosis often prevents RVOTO development.

Key Words: Taussig–Bing heart • Arterial switch operation • Pulmonary stenosis

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