Journal
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
Volume 159, Issue 2, Pages 592-599Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jtcvs.2019.07.103
Keywords
arterial switch operation; transposition of the great arteries; aortic arch obstruction
Funding
- Victoria Government's Operational Infrastructure Support Program
- National Health and Medical Research Council [1134203, 1082186]
- National Health and Medical Research Council of Australia [1134203] Funding Source: NHMRC
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Objective: Transposition of the great arteries or Taussig-Bing anomaly with concomitant aortic arch obstruction is uncommon, with limited data on long-term outcomes after arterial switch operation and aortic arch obstruction repair. This study sought to determine outcomes of patients undergoing arterial switch operation and aortic arch obstruction repair at a single institution. Methods: From 1983 to 2015, 844 patients underwent an arterial switch operation for biventricular repair at The Royal Children's Hospital. Eighty-three (9.8%, 83/844) patients underwent an arterial switch operation and aortic arch obstruction repair. Results: Fifty-five (66%, 55/83) patients had transposition of the great arteries. and 28 (34%, 28/83) patients had Taussig-Bing anomaly. Fifty-nine (71%, 59/83) patients underwent arterial switch operation and aortic arch obstruction repair as a single-stage procedure, and 24 (29%, 24/83) patients underwent arterial switch operation and aortic arch obstruction repair as a 2-stage procedure. There were 5 early deaths (6.0%, 5/83). Follow-up was available for 74 (95%) of the 78 survivors. Median follow-up was 13.3 years (interquartile range, 7.3-19.3 years; range, 1-30 years). There were no late deaths. Freedom from reintervention was 77%, 71%, and 68% at 5, 10, and 20 years, respectively. Reintervention was more common compared with patients without aortic arch obstruction (P<.001). Reintervention for right-sided obstruction was more common compared with patients without aortic arch obstruction (P=.006). Conclusions: Patients with transposition of the great arteries or Taussig-Bing anomaly with associated aortic arch obstruction have a higher reintervention rate, especially for right-sided obstruction. Closer monitoring of this subgroup of patients is warranted.
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