Outcomes of single-stage correction of Taussig-Bing anomaly with concomitant aortic arch obstruction.

Abstract

Introduction: Conventionally, the surgical approach for Taussig-Bing anomaly (TBA) and transposition of the great arteries with aortic arch obstruction (AAO) has often involved a two-stage strategy. However, in contemporary practice, most centers now favor a one-stage repair. Despite this trend, the choice between one-stage and two-stage strategies may still arise in specific anatomical cases, such as those with interrupted AA (IAA) or in low-weight infants.

Patients and methods: We conducted a review of our institutional experience with single-stage correction in 24 consecutive cases of TBA associated with AAO. Each patient underwent a single-stage correction that included an arterial switch operation (ASO) along with ventricular septal defect (VSD) closure through baffling of the left ventricle to the neo-aorta and AA repair. Early mortality or reoperation was defined as death or the need for reoperation occurring prior to hospital discharge or within 30 days following ASO. Reintervention was classified as either a reoperation or a transcatheter procedure.

Results: The study comprised 24 cases. Among them, 6 (25%) patients had TBA with aortic coarctation, 15 (62.5%) patients had TBA with hypoplastic AA (HAA), 2 (8.3%) patients presented with TBA and IAA, and one patient had TBA with HAA alongside partial anomalous pulmonary venous connection. There were two early postoperative deaths (8.3%). Recoarctation occurred in 2 (8.3%) cases, both of which involved TBA with AA hypoplasia. Both patients successfully underwent balloon dilation of the coarctation after 285 and 312 days, respectively. One (4.2%) patient developed subaortic stenosis and underwent a modified Konno procedure after 233 days. The total number of reinterventions was 5 (20.8%), which included three cardiac catheterization procedures (two successful balloon dilations of the coarctation and one unsuccessful balloon dilation of the supravalvular stenosis), along with two surgical reinterventions.

Conclusions: The single-stage repair involving VSD closure, AA reconstruction, and ASO is an applicable and safe option for patients with combined TBA and concomitant AAO. We recorded reinterventions for recurrent coarctation, supravalvular, and subvalvular aortic stenosis. Long-term follow-up is essential, and early percutaneous interventions may help lower the rates of repeat surgeries.