title: Outcomes of the arterial switch operation in patients with Taussig-Bing anomaly.
abstract: 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.
authors.affiliation: Department of Cardiac Surgery, Royal Children's Hospital, and Department of Paediatrics, The University of Melbourne, Melbourne, Australia.
authors.forename: Natalie
authors.initials: N
authors.lastname: Soszyn
authors.forename: Tyson A
authors.initials: TA
authors.lastname: Fricke
authors.forename: Gavin R
authors.initials: GR
authors.lastname: Wheaton
authors.forename: James M
authors.initials: JM
authors.lastname: Ramsay
authors.forename: Yves
authors.initials: Y
authors.lastname: d'Udekem
authors.forename: Christian P
authors.initials: CP
authors.lastname: Brizard
authors.forename: Igor E
authors.initials: IE
authors.lastname: Konstantinov
mesh_terms: D000206:Actuarial Analysis; D001011:Aorta / Q000601:surgery; D001724:Birth Weight; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004310:Double Outlet Right Ventricle / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000401:mortality* / Q000601:surgery; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D014188:Transposition of Great Vessels / Q000401:mortality / Q000601:surgery; D055815:Young Adult