Improved results with single-stage total correction of Taussig–Bing anomaly☆
Bibliographic record
Abstract
OBJECTIVE: The arterial-switch operation (ASO) for management of Taussig-Bing anomaly is associated with important morbidity, mainly related to multiple associated cardiac anomalies. Our surgical management has evolved to suggest a single-stage total repair strategy tailored to address all abnormalities on an individual basis. We examine the efficacy of this treatment approach. METHODS: Thirty-three children, (infants n=29), with Taussig-Bing underwent ASO (1979-2005). In our earlier experience (group 1, n=17), initial palliation was performed as needed, including pulmonary-artery banding (n=9), coarctation repair (n=6), and atrial septostomy (n=3) followed by ASO at a later age. In our later experience (group 2, n=16), single-stage total repair was performed; ASO with ventricular septal defect closure and baffling of left ventricle to neo-aorta performed in neonates with arch obstruction (n=8), or at age 6 weeks in those with no arch obstruction (n=8). Concomitant relief of right-ventricle outflow-tract obstruction (RVOTO) was performed in 14 patients. Demographics and operative variables affecting outcomes were analyzed. RESULTS: Mean age at operation for group 1 and 2 patients was 312+/-477 and 42+/-31 days (p<0.0001). Aortic arch obstruction (52%), sub-aortic RVOTO (61%) and unusual coronary patterns (52%) were similar for both groups. One-year survival for group 1 and 2 patients was 47+/-5% and 100% (p=0.001). Associated anomalies such as great vessels position, arch obstruction, and unusual coronaries were not significant risk factors for mortality on multivariable analysis. Ten-year freedom from RVOT and arch re-operation was 55+/-5% and 96+/-4%. Five-year event-free survival for groups 1 and 2 was 35+/-6% and 87+/-1% (p=0.0016). Significant factors affecting event-free survival were group 1 (HR 108, p=0.0005), and larger weight at surgery (HR 1.3, p=0.02). CONCLUSIONS: The Taussig-Bing anomaly is complex and often associated with other cardiac anomalies (arch obstruction, RVOTO, unusual coronary pattern). Advances in perioperative care have significantly mitigated mortality. In our experience with single-stage total repair, event-free survival, especially freedom from RVOT re-operation, has significantly improved.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".