Right Ventricular Outflow Tract Obstruction after the Arterial Switch Operation for Taussig-Bing Anomaly Repair
Presented During:
Sunday, May 15, 2022: 2:00PM - 2:15PM
Hynes Convention Center
Posted Room Name:
Room 210
Abstract No:
1921
Submission Type:
Abstract Submission
Authors:
Carlos Bonilla-Ramirez (1), Saul Flores (1), Nicholas Stephens (2), Jeffrey Heinle (1), Emmett McKenzie (1), Christopher Caldarone, MD (1)
Institutions:
(1) Texas Children's Hospital, Houston, TX, (2) Texas Children’s Hospital – Baylor College of Medicine, N/A
Submitting Author:
Carlos Bonilla-Ramirez
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Texas Children's Hospital
Texas Children's Hospital
Co-Author(s):
Saul Flores
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Texas Children's Hospital
Texas Children's Hospital
Adam Stephens
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Texas Children’s Hospital – Baylor College of Medicine
Texas Children’s Hospital – Baylor College of Medicine
*Jeffrey Heinle
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Texas Children's Hospital
Texas Children's Hospital
Emmett McKenzie
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Texas Children's Hospital
Texas Children's Hospital
*Christopher Caldarone
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Texas Children's Hospital
Texas Children's Hospital
Presenting Author:
Carlos Bonilla-Ramirez
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Texas Children's Hospital
Texas Children's Hospital
Abstract:
Objective: Right ventricular outflow tract (RVOT) obstruction remains a frequent complication after Taussig-Bing anomaly repair. We studied anatomic and operative variables for association with freedom from RVOT reintervention after the arterial switch operation among patients with a Taussig-Bing anomaly.
Methods: Retrospective review identified all patients with a Taussig-Bing anomaly who underwent an arterial switch operation from 1995-2020 at a single institution. We calculated the pulmonary to aortic valve diameter ratio (P/A ratio) and aortic arch Z-scores from echocardiography-derived data. Freedom from RVOT reintervention was modeled as a time-to-event variable. The Kaplan-Meier estimator, log-rank test, and Cox-proportional hazards regression analysis studied factors for association with freedom from RVOT reintervention.
Results: Forty-one patients with Taussig-Bing anomaly underwent arterial switch (median age: 39d). Subaortic resection was performed in 20/41 (48%) patients, arch repair in 24/41 (58%) patients, and LeCompte maneuver in 35/41 (85%) patients. LeCompte maneuver was not performed in 6/41 patients (two with posterior aorta and four with great vessels size discrepancy). At median follow-up of 8 years, there was 93% survival and 69% freedom from RVOT reintervention. At 8 years, risk factors for RVOT reintervention included requirement for arch repair (50% vs 94%, p=0.008), no LeCompte maneuver (28% vs 75%, p=0.05), and lower aortic arch Z-scores (HR 0.5, p=0.03); while P/A ratio was not associated with RVOT reintervention (HR=3.2, p=0.2). At 8 years, freedom from RVOT reintervention was 93% in 16 patients with LeCompte (no arch repair), 59% in 19 patients with arch repair and LeCompte, and 28% in 6 patients with arch repair (no LeCompte) (p=0.02, Figure).
Conclusions: Aortic arch repair in patients with an aortopulmonary relationship unsuitable for a LeCompte maneuver was associated with a high burden of RVOT reinterventions.
Methods: Retrospective review identified all patients with a Taussig-Bing anomaly who underwent an arterial switch operation from 1995-2020 at a single institution. We calculated the pulmonary to aortic valve diameter ratio (P/A ratio) and aortic arch Z-scores from echocardiography-derived data. Freedom from RVOT reintervention was modeled as a time-to-event variable. The Kaplan-Meier estimator, log-rank test, and Cox-proportional hazards regression analysis studied factors for association with freedom from RVOT reintervention.
Results: Forty-one patients with Taussig-Bing anomaly underwent arterial switch (median age: 39d). Subaortic resection was performed in 20/41 (48%) patients, arch repair in 24/41 (58%) patients, and LeCompte maneuver in 35/41 (85%) patients. LeCompte maneuver was not performed in 6/41 patients (two with posterior aorta and four with great vessels size discrepancy). At median follow-up of 8 years, there was 93% survival and 69% freedom from RVOT reintervention. At 8 years, risk factors for RVOT reintervention included requirement for arch repair (50% vs 94%, p=0.008), no LeCompte maneuver (28% vs 75%, p=0.05), and lower aortic arch Z-scores (HR 0.5, p=0.03); while P/A ratio was not associated with RVOT reintervention (HR=3.2, p=0.2). At 8 years, freedom from RVOT reintervention was 93% in 16 patients with LeCompte (no arch repair), 59% in 19 patients with arch repair and LeCompte, and 28% in 6 patients with arch repair (no LeCompte) (p=0.02, Figure).
Conclusions: Aortic arch repair in patients with an aortopulmonary relationship unsuitable for a LeCompte maneuver was associated with a high burden of RVOT reinterventions.
CONGENTIAL:
Neonatal and Pediatric Cardiac Surgery
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