100. Right Ventricular Outflow Tract Obstruction after the Arterial Switch Operation for Taussig-Bing Anomaly Repair
University Of Michigan
Ann Arbor, MI
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Jennifer C. Romano, M.D., M.S. is the Herbert Sloan Collegiate Professor of Cardiac Surgery at the University of Michigan Medical School, specializing in surgery for congenital and pediatric acquired heart disease. Her practice encompasses all elements of pediatric cardiac surgery with a focus on neonatal surgery and hybrid interventions. She serves as the Program Director for the University of Michigan ACGME Congenital Heart Surgery Residency. The University of Michigan C.S. Mott Children’s Hospital Congenital Heart Center is internationally recognized as a leader in the care of patients with congenital heart disease (CHD), performing 500-600 open-heart and 1000 total operations each year. Dr. Romano is also active nationally as a Director for the American Board of Thoracic Surgery, Congenital Deputy Editor for Annals of Thoracic Surgery, the Second Vice President for the Society of Thoracic Surgeons, and as Secretary-Treasurer for the Congenital Heart Surgeons Society.
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I am a native Texan, Texas Longhorn and graduate of The University of Texas at Austin. I attended medical school and completed my General Surgery residency at UT Houston Medical School and Memorial Hermann Hospital. My Cardiothoracic Surgery fellowship was completed at UT Southwestern Medical Center in Dallas. I have worked in the field of Congenital Heart Surgery at Children's Medical Center in Dallas, Dell Children's Medical Center in Austin and Texas Children's Hospital in Houston. I am the current ACGME Congenital Heart Surgery Fellow at Texas Children's Hospital in Houston.
Abstract
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.