Mid-to-long term fate of neo-aortic root after arterial switch operation for Taussig-Bing anomaly: A retrospective study in a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GU Mingjun , CHEN Dian , HU Renjie , HU Jie , DONG Wei , ZHANG Wen , JIANG Qi , ZHU Yifan ,  ZHANG Haibo

1. Department of Pediatric Thoracic and Cardiovascular Surgery, Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200127, P. R. China;

Corresponding author：

ZHANG Haibo, Email: zhanghaibosh@126.com

Keywords：

Taussig-Bing anomaly; arterial switch operation; aortic root dilation; aortic regurgitation

DOI：

10.7507/1007-4848.202208085

Video：

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Objective To explore growth pattern of neo-aortic root as well as development of neo-aortic regurgitation after arterial switch operation (ASO) for Taussig-Bing anomaly. Methods From 2002 to 2017, the patients who received ASO, and were discharged alive from Shanghai Children’s Medical Center and followed up for more than 3 years were retrospectively involved in this study. Results A total of 127 patients were enrolled. There were 98 (77.2%) males, the median age at ASO was 73.0 d and the average weight was 4.7 kg. Forty-five (35.4%) children were complicated with mild or mild-to-moderate pulmonary insufficiency (PI) before ASO. The average follow-up time was 7.0 years. During the follow-up, 14 (11.0%) children presented moderate or greater neo-aortic regurgitation (neo-AR). The diameter of neo-aortic annulus and sinus of Valsalva was beyond normal range during the entire follow-up. The average diameter of neo-aortic annulus was 18.0 mm at 5 years and 20.5 mm at 10 years. The average diameter of sinus of Valsalva was 25.9 mm at 5 years and 31.1 mm at 10 years. Neo-AR continued to develop over time. The diameter of children who developed moderate or greater neo-AR was constantly larger than that of children who did not (χ²=18.3, P<0.001). Preoperative mild or mild-to-moderate PI was an independent risk factor for the development of moderate or greater neo-AR during mid-to-long term follow-up (c-HR=3.46, P=0.03). Conclusion The diameters of neo-aortic annulus and sinus of Valsalva of Taussig-Bing children who receive ASO repair continue to expand without normalization. The dilation of annulus correlates with the development of neo-AR. PI before ASO repair increases the risk of neo-AR development.

Citation： GU Mingjun, CHEN Dian, HU Renjie, HU Jie, DONG Wei, ZHANG Wen, JIANG Qi, ZHU Yifan, ZHANG Haibo. Mid-to-long term fate of neo-aortic root after arterial switch operation for Taussig-Bing anomaly: A retrospective study in a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(4): 504-509. doi: 10.7507/1007-4848.202208085 Copy

1.	Alsoufi B. Single-stage neonatal repair of Taussig-Bing anomaly. Operat Techniq Thorac Cardiovasc Surg, 2014, 19(4): 464-481.
2.	Vergnat M, Baruteau AE, Houyel L, et al. Late outcomes after arterial switch operation for Taussig-Bing anomaly. J Thorac Cardiovasc Surg, 2015, 149(4): 1124-1130.
3.	Ma K, Li S, Hu S, et al. Neoaortic valve regurgitation after arterial switch: Ten years outcomes from a single center. Ann Thorac Surg, 2016, 102(2): 636-642.
4.	Atalay A, Gocen U. Early and midterm results of the arterial switch operation: A 9-year, single-center experience. Heart Surg Forum, 2017, 20(1): E015-E018.
5.	Schwarz F, Blaschczok HC, Sinzobahamvya N, et al. The Taussig-Bing anomaly: Long-term results. Eur J Cardiothorac Surg, 2013, 44(5): 821-827.
6.	Koolbergen DR, Manshanden JS, Yazdanbakhsh AP, et al. Reoperation for neoaortic root pathology after the arterial switch operation. Eur J Cardiothorac Surg, 2014, 46(3): 474-479.
7.	Bokenkamp R, Aguilar E, van der Palen RL, et al. Reoperation for right ventricular outflow tract obstruction after arterial switch operation for transposition of the great arteries and aortic arch obstruction. Eur J Cardiothorac Surg, 2016, 49(5): e91-e96.
8.	Choi KH, Sung SC, Kim H, et al. Transposition complex with aortic arch obstruction: Outcomes of one-stage repair over 10 years. Pediatr Cardiol, 2016, 37(1): 160-166.
9.	Vida VL, Zanotto L, Zanotto L, et al. Left-sided reoperations after arterial switch operation: A European multicenter study. Ann Thorac Surg, 2017, 104(3): 899-906.
10.	Nakayama Y, Shinkawa T, Matsumura G, et al. Late neo-aortic valve regurgitation long after arterial switch operation. Ann Thorac Surg, 2019, 108(4): 1210-1216.
11.	Oda S, Nakano T, Fujita S, et al. Long-term growth of the neoaortic root after arterial switch operation. Ann Thorac Surg, 2019, 107(4): 1203-1211.
12.	Cha SG, Baek JS, Yu JJ, et al. Growth pattern of the neo-aorta after arterial switch operation during childhood. Korean Circ J, 2021, 51(1): 83-93.
13.	van der Palen RLF, van der Bom T, Dekker A, et al. Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation. Heart, 2019, 105(22): 1732-1740.
14.	Pettersen MD, Du W, Skeens ME, et al. Regression equations for calculation of Z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: An echocardiographic study. J Am Soc Echocardiogr, 2008, 21(8): 922-934.
15.	Arcieri L, Brambilla A, Ravaglioli A, et al. Neo-aortic posterior sinus of Valsalva reduction and closed coronary artery transfer as a method to approach aortopulmonary mismatch in transposition of great arteries. J Card Surg, 2021, 36(10): 3665-3670.
16.	Lo Rito M, Fittipaldi M, Haththotuwa R, et al. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg, 2015, 149(4): 1089-1094.
17.	Fricke TA, Thungathurthi K, Naimo PS, et al. Arterial switch operation in patients with Taussig-Bing anomaly and aortic arch obstruction. Ann Thorac Surg, 2022, 114(3): 834-840.
18.	Takada T, Asagai S, Sato M, et al. Predictors of neo-aortic valve regurgitation in the long term after arterial switch operation. Heart Vessels, 2021, 36(5): 693-703.
19.	Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J, 2021, 42(6): 563-645.
20.	Brister KA, Shores JC, Salazar JD, et al. Recurrent neoaortic insufficiency after the switch back operation with previous repair of transposition with ventricular septal defect and aortic arch hypoplasia. World J Pediatr Congenit Heart Surg, 2015, 6(1): 135-138.

1. Alsoufi B. Single-stage neonatal repair of Taussig-Bing anomaly. Operat Techniq Thorac Cardiovasc Surg, 2014, 19(4): 464-481.
2. Vergnat M, Baruteau AE, Houyel L, et al. Late outcomes after arterial switch operation for Taussig-Bing anomaly. J Thorac Cardiovasc Surg, 2015, 149(4): 1124-1130.
3. Ma K, Li S, Hu S, et al. Neoaortic valve regurgitation after arterial switch: Ten years outcomes from a single center. Ann Thorac Surg, 2016, 102(2): 636-642.
4. Atalay A, Gocen U. Early and midterm results of the arterial switch operation: A 9-year, single-center experience. Heart Surg Forum, 2017, 20(1): E015-E018.
5. Schwarz F, Blaschczok HC, Sinzobahamvya N, et al. The Taussig-Bing anomaly: Long-term results. Eur J Cardiothorac Surg, 2013, 44(5): 821-827.
6. Koolbergen DR, Manshanden JS, Yazdanbakhsh AP, et al. Reoperation for neoaortic root pathology after the arterial switch operation. Eur J Cardiothorac Surg, 2014, 46(3): 474-479.
7. Bokenkamp R, Aguilar E, van der Palen RL, et al. Reoperation for right ventricular outflow tract obstruction after arterial switch operation for transposition of the great arteries and aortic arch obstruction. Eur J Cardiothorac Surg, 2016, 49(5): e91-e96.
8. Choi KH, Sung SC, Kim H, et al. Transposition complex with aortic arch obstruction: Outcomes of one-stage repair over 10 years. Pediatr Cardiol, 2016, 37(1): 160-166.
9. Vida VL, Zanotto L, Zanotto L, et al. Left-sided reoperations after arterial switch operation: A European multicenter study. Ann Thorac Surg, 2017, 104(3): 899-906.
10. Nakayama Y, Shinkawa T, Matsumura G, et al. Late neo-aortic valve regurgitation long after arterial switch operation. Ann Thorac Surg, 2019, 108(4): 1210-1216.
11. Oda S, Nakano T, Fujita S, et al. Long-term growth of the neoaortic root after arterial switch operation. Ann Thorac Surg, 2019, 107(4): 1203-1211.
12. Cha SG, Baek JS, Yu JJ, et al. Growth pattern of the neo-aorta after arterial switch operation during childhood. Korean Circ J, 2021, 51(1): 83-93.
13. van der Palen RLF, van der Bom T, Dekker A, et al. Progression of aortic root dilatation and aortic valve regurgitation after the arterial switch operation. Heart, 2019, 105(22): 1732-1740.
14. Pettersen MD, Du W, Skeens ME, et al. Regression equations for calculation of Z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: An echocardiographic study. J Am Soc Echocardiogr, 2008, 21(8): 922-934.
15. Arcieri L, Brambilla A, Ravaglioli A, et al. Neo-aortic posterior sinus of Valsalva reduction and closed coronary artery transfer as a method to approach aortopulmonary mismatch in transposition of great arteries. J Card Surg, 2021, 36(10): 3665-3670.
16. Lo Rito M, Fittipaldi M, Haththotuwa R, et al. Long-term fate of the aortic valve after an arterial switch operation. J Thorac Cardiovasc Surg, 2015, 149(4): 1089-1094.
17. Fricke TA, Thungathurthi K, Naimo PS, et al. Arterial switch operation in patients with Taussig-Bing anomaly and aortic arch obstruction. Ann Thorac Surg, 2022, 114(3): 834-840.
18. Takada T, Asagai S, Sato M, et al. Predictors of neo-aortic valve regurgitation in the long term after arterial switch operation. Heart Vessels, 2021, 36(5): 693-703.
19. Baumgartner H, De Backer J, Babu-Narayan SV, et al. 2020 ESC guidelines for the management of adult congenital heart disease. Eur Heart J, 2021, 42(6): 563-645.
20. Brister KA, Shores JC, Salazar JD, et al. Recurrent neoaortic insufficiency after the switch back operation with previous repair of transposition with ventricular septal defect and aortic arch hypoplasia. World J Pediatr Congenit Heart Surg, 2015, 6(1): 135-138.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Mid-to-long term fate of neo-aortic root after arterial switch operation for Taussig-Bing anomaly: A retrospective study in a single center

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