Primary Arterial Switch Operation as a Strategy for Total Correction of Taussig – Bing Anomaly A 21 - Year Experience

Taussig–Bing anomaly is a rare congenital cardiac malformation, first described in 1949 by Helen B. Taussig and Richard J. Bing. The second most common variant of double outlet right ventricle, the anomaly was originally distinguished by a transposed aorta arising entirely from the right ventricle, a pulmonary artery overriding a ventricular septal defect (VSD), side-by-side great vessels, and bilateral subarterial conus with absence of pulmonary–mitral fibrous continuity. Most surgical series have expanded the definition to include any double outlet right ventricle (with or without pulmonary–mitral continuity) with a subpulmonary VSD, in which left ventricular output flows preferentially to the pulmonary artery. Despite >30 years of experience with various management strategies, Taussig–Bing anomaly continues to present a considerable surgical challenge. This is largely related to associated anomalies, the most significant of which may be the varying degrees of right ventricular outflow tract and aortic arch obstruction caused by a malaligned ventricular septum. Today, primary arterial switch operation (ASO) with VSD closure is the gold standard for Taussig–Bing anomaly. Significant rates of reintervention, mortality, and neoaortic complications have been demonstrated in studies of this lesion, particularly in patients who had undergone palliative procedures such as pulmonary artery banding before definitive repair. Since 1990, single-stage correction with primary ASO has been our institution’s practice for all children with Taussig–Bing anomaly. We aimed to describe the long-term outcomes and functional status of patients managed with this surgical approach and to identify factors that predict mortality, reintervention, neoaortic insufficiency (AI), and neoaortic root dilation.