Coronary events after arterial switch operation for transposition of the great arteries
A Legendre1, J Losay, A Touchot-Koné
1Centre Chirurgical Marie-Lannelongue, 133 avenue de la Resistance, 92350 Le Plessis-Robinson, France. alegendre@ccml.com
Insights
Coronary events after arterial switch operation (ASO) for transposition of the great arteries are common, particularly early on, and can be fatal. Coronary artery angiography is recommended for diagnosis due to insufficient sensitivity of noninvasive tests.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- The arterial switch operation (ASO) is a critical procedure for transposition of the great arteries.
- Coronary artery transfer is a key component of ASO.
- Post-ASO coronary events pose a significant risk.
Purpose of the Study:
- To determine the incidence and risk factors of coronary events following ASO.
- To evaluate the sensitivity of noninvasive tests in diagnosing coronary obstruction post-ASO.
Main Methods:
- Retrospective analysis of 1304 patients undergoing ASO between 1982 and 2001.
- Follow-up of 1198 hospital survivors for a median of 59 months.
- Coronary angiography in 324 patients; noninvasive tests (ECG, echocardiogram, treadmill, scintigraphy) in subsets.
Main Results:
- Coronary events occurred in 7.2% of patients, with a bimodal incidence (early and later).
- Risk factors included specific coronary patterns (Type B/C) and operative events.
- Coronary angiography revealed lesions in 6.8% of patients.
- Combined noninvasive tests achieved 75% sensitivity for diagnosis.
Conclusions:
- Coronary events are a significant and not infrequent complication after ASO, impacting survival.
- Noninvasive diagnostic tests lack sufficient sensitivity for delayed coronary artery stenosis.
- Coronary artery angiography is essential for accurate diagnosis and management.
Background:
Transfer of the coronary arteries is a crucial step during the arterial switch operation (ASO) for transposition of the great arteries. This retrospective study aims to assess the incidence and risk factors of coronary events after ASO and sensitivity of noninvasive tests in the diagnosis of the coronary obstruction.
Methods And Results:
Between 1982 and 2001, 1304 newborn and infants had an ASO and the 1 198 hospital survivors had a 59-month mean follow-up. Coronary events occurred in 94 patients (7.2%; 95% CI, 6 to 9). Survival without coronary events were 92.7, 91, and 88.2% at 1, 10, and 15 years, respectively. The incidence was bimodal: high early and slow later. Multivariate analysis showed correlation with type B or C coronary pattern and major operative events (P<0.0001 and P=0.0024). In a subset of 324 patients who underwent a coronary artery angiography, lesions were observed in 22 patients (6.8%; 95% CI, 5 to 10). Multivariate analysis showed correlation with only type B or C coronary pattern (OR=20.8, P=0.0002). All of these patients had electrocardiogram and echocardiogram, 174 patients also had a treadmill test, and 115 patients had a myocardial scintigraphy. The association of these tests had the highest diagnosis sensitivity, 75%.
Conclusions:
After ASO, coronary events are not rare, occurring most often early and are an important cause of death. Coronary repair can be needed lately. Noninvasive tests are not sensitive enough to detect significant delayed coronary artery stenosis and coronary artery angiography should be performed.
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