title: Arterial Switch for Transposition of the Great Arteries With Large Ventricular Septal Defect and for Taussig Bing Anomaly: Experience From a Tertiary Care Center in the Developing World.
abstract: BACKGROUND
  Results of the arterial switch operation (ASO) for transposition of the great arteries (TGA) with large ventricular septal defect (VSD) and for Taussig Bing anomaly (TBA) in a tertiary care center of a developing country were retrospectively analyzed.
  
  
  METHODS
  From January 2007 through June 2013, a total of 30 patients with TBA and 54 patients having TGA with large VSD underwent ASO with VSD closure. Age at surgery for TBA was 27 days to 7 years (median age 3 months) and for TGA with VSD it was 1 day to 6 years (median age 2 months). In all, 46.7% of patients with TBA and 30% of patients with TGA/VSD presented with sepsis secondary to pneumonitis and were taken for surgery when the infection was under control. In all, 13% of patients with TBA and 5.5% of patients with TGA/VSD were on intermittent positive pressure ventilation (IPPV) prior to and continuing up to the time of surgery.
  
  
  RESULTS
  On multivariate analysis, factors associated with mortality were the presence of preoperative IPPV for pneumonia (P < .006) and the need for peritoneal dialysis following surgery (P < .028). Neither diagnosis of TBA or TGA/VSD nor any associated anatomical feature (including aortic arch obstruction, unusual coronary anatomy, great artery relationship, or mitral valve anomaly) was found to be related to high early mortality or late complications. Follow-up was 92% complete, with a mean duration of follow-up of 4.1 years. Freedom from reoperation was 98% at five years, and actuarial survival was 83.3% at five years.
  
  
  CONCLUSIONS
  Our experience at a tertiary center in a developing country suggests that preoperative need for IPPV for pneumonia is a major determining factor for mortality and morbidity in patients undergoing ASO for TBA and TGA/VSD. This appears to be of greater consequence than details of the underlying disease per se.
authors.affiliation: Department of Paediatric Cardiac Surgery, Fortis Escorts Heart Institute & Research Center, New Delhi, India.
authors.forename: Mohammad Eliyas
authors.initials: ME
authors.lastname: Patwary
authors.affiliation: Department of Paediatric Cardiac Surgery, Fortis Escorts Heart Institute & Research Center, New Delhi, India.
authors.forename: Mohammad Shahbaz
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Department of Pediatric Cardiology, Fortis Escorts Heart Institute & Research Center, New Delhi, India.
authors.forename: Ashutosh
authors.initials: A
authors.lastname: Marwah
authors.affiliation: Department of Pediatric Critical Care, Fortis Escorts Heart Institute & Research Center, New Delhi, India.
authors.forename: Vishal
authors.initials: V
authors.lastname: Singh
authors.affiliation: Department of Biostatistics, Fortis Escorts Heart Institute & Research Center, New Delhi, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Shekhawat
authors.affiliation: Department of Paediatric Cardiac Surgery, Fortis Escorts Heart Institute & Research Center, New Delhi, India rsharmacvs@hotmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sharma
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D002675:Child, Preschool; D004310:Double Outlet Right Ventricle / Q000601:surgery*; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome
keywords: Taussig Bing anomaly; arterial switch operation; d transposition of great arteries; infection