Transposition of Great Arteries with Complex Coronary Artery Variants: Time-Related Events Following Arterial Switch
Shada Al Anani1, Ibtihaj Fughhi2, Anas Taqatqa2
1Rush University Medical Center, Chicago, IL, USA. sjalanani@gmail.com.
Insights
Arterial switch operation (ASO) outcomes are not worsened by single, intramural, or inverted coronary artery variants. While an early risk exists, long-term survival after ASO is not affected by these nonstandard coronary patterns.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Coronary artery anatomy is a critical factor influencing outcomes in arterial switch operations (ASO).
- The impact of specific nonstandard coronary artery variants on ASO outcomes remains incompletely understood.
- Identifying risks associated with coronary anomalies is crucial for surgical planning and patient management.
Purpose of the Study:
- To compare early and late outcomes in patients undergoing ASO with different types of nonstandard coronary artery variants.
- To determine if specific variants like single, intramural, or inverted coronary arteries pose additional risks post-ASO.
- To evaluate the long-term safety and efficacy of ASO in the presence of coronary anomalies.
Main Methods:
- Retrospective review of patients who underwent ASO between January 1995 and October 2010.
- Inclusion of patients with coronary artery variants classified as nonstandard (excluding L1Cx1R2 by Leiden classification).
- Categorization into Group A (single, intramural, inverted variants) and Group B (other nonstandard variants) for comparative analysis of outcomes.
Main Results:
- Out of 123 ASO procedures, 24 patients (19.5%) had nonstandard coronary variants (13 in Group A, 11 in Group B).
- Early mortality was low and similar between groups (2 deaths total), with one additional death shortly after discharge in Group A.
- No structural coronary artery failure was observed post-discharge; 8-year freedom from reintervention was 78.3%, with no late neo-aortic or mitral valve interventions.
Conclusions:
- Single, intramural, or inverted coronary artery courses do not appear to confer additional longitudinal risk for structural or flow impairment after ASO within the nonstandard variant cohort.
- There is an identifiable early hazard period following ASO with these variants, but no significant late survival attrition.
- Aortic arch repair performed as part of a staged approach before ASO may influence both early and late surgical outcomes.
Abstract:
Coronary artery anatomy represents a challenging and, often, determining predictor of outcome in an arterial switch operation (ASO). Impact of specific coronary artery variants, such as single, intramural and inverted, on time-related events following ASO, is, yet, to be determined. We sought to compare early and late outcomes within the group of nonstandard coronary artery variants. Patients who underwent ASO from January 1995 to October 2010 were reviewed. Patients with coronary artery variants other than L1Cx1R2 ("standard" by Leiden classification) were included. Patients with single, intramural and inverted coronary artery variants incorporated in group A. All other nonstandard coronary variants incorporated in group B. Demographics, perioperative variables, early and late outcomes were assessed. Of the 123 ASO, 24 patients (19.5%) with nonstandard coronary variant were studied. Thirteen were in group A and 11 in group B. There were two early deaths (1 in group A and 1 in group B) (p > 0.05). There is one death early after hospital discharge (group A). Mean follow-up was 59.4 ± 55.1 months. There was no structural coronary artery failure after hospital discharge following ASO. Freedom from any reintervention at 8 years was (78.3 ± 9.6%) (p 0.55) with no late neo-aortic or mitral valve intervention. ASO with single, intramural or inverted coronary artery course carries no added longitudinal risk for structural or flow impairment within the group of nonstandard coronary artery variants. There is an early hazard period with no late survival attrition. Aortic arch repair as part of staged strategy prior to ASO might influence early and late outcome.
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