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Published on: September 15, 2023
[Influence of coronary artery variation on the outcome of arterial switch operation]
Xiang-ming Fan1, Jun Yan, Ying-long Liu
1Department of Cardiac Surgery, Chinese Academy of Medical Sciences & Peking Union Medical College, Fuwai Hospital & Cardiovascular Institute, Beijing 100037, China.
Insights
Coronary artery variation in patients undergoing arterial switch operation for transposition of great arteries is associated with increased operative difficulty and higher early mortality. Improved surgical techniques may reduce these risks.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Transposition of great arteries (TGA) is a critical congenital heart defect.
- Arterial switch operation (ASO) is the preferred surgical repair for TGA.
- Anatomical variations, particularly in coronary arteries, can complicate ASO.
Purpose of the Study:
- To evaluate the impact of coronary artery variations on the outcomes of ASO in TGA patients.
- To compare the results between patients with and without coronary artery variations.
Main Methods:
- Retrospective analysis of 280 patients who underwent ASO between 2001 and 2008.
- Categorization into a variant group (73 patients with coronary variations) and a usual group (207 patients).
- Surgical technique involved coronary artery transfer via button implantation to the neo-aorta.
Main Results:
- The variant group showed a significantly higher early mortality rate (16.4% vs. 8.21%, P < 0.05).
- Longer cardiopulmonary bypass and cross-clamp times were observed in the variant group (P < 0.05).
- Intraoperative coronary compression/obstruction occurred in 6 cases; common complications included infection and low output syndrome.
Conclusions:
- Coronary artery variations present significant challenges during ASO for TGA.
- These variations adversely affect surgical outcomes, increasing mortality.
- Enhanced surgical expertise is crucial for mitigating risks associated with coronary anomalies in ASO.
Objective:
To investigate the influence of coronary artery variation on the outcome of arterial switch operation for transposition of great arteries.
Methods:
Among 280 patients undergoing arterial switch operations at our hospital from 2001 to 2008, 73 (26.1%) had concurrent coronary arteries variation (54 males and 19 females; median age: 0.6 ± 1.1 years old; mean body weight: 5.8 ± 2.6 kg). Of these 73 patients (variant group), 21 cases had transposition of great arteries with a ventricular septal defect and 30 cases with an intact ventricular septum. The other 22 cases were of Taussig-Bing anomalies. Another 207 cases had usual coronary arteries (usual group). Coronary artery transfer was achieved by implantation of buttons to the previously anastomosed neo-aorta.
Results:
There were 29 early death (10.4%) including 12 cases (16.4%) in variant group and 17 cases (8.21%) in usual group (P < 0.05). Mean cardiopulmonary bypass and cross-clamp durations were 229 ± 84 and 146 ± 48 min in variant group while 206 ± 59 and 137 ± 40 min in usual group (P < 0.05). Six cases were confirmed intra-operatively as coronary compression or obstruction. Complications included infection (n = 11), low output syndrome (n = 7), diaphragm paralysis (n = 3), pericardial effusion (n = 2) and atrioventricular block (n = 2).
Conclusion:
Coronary artery variation increases the operative difficulty and influences the outcome. The operative proficiency may decrease the mortality.
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