Reoperation for coronary artery stenosis after arterial switch operation
Joon Chul Jung1, Jae Gun Kwak1, Eung Re Kim1
1Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
Coronary artery stenosis after arterial switch operation (ASO) necessitates reoperation. Unroofing and cut-back angioplasty show good results for managing this ASO complication.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease Management
Background:
- Coronary artery stenosis is a significant complication following arterial switch operation (ASO).
- This stenosis can necessitate reoperation, impacting patient outcomes.
- Effective management strategies are crucial for improving long-term results.
Purpose of the Study:
- To investigate the indications for reoperation in patients with coronary artery stenosis post-ASO.
- To evaluate the outcomes of reoperation techniques for coronary artery stenosis after ASO.
- To suggest improvements for the management protocol of coronary artery stenosis following ASO.
Main Methods:
- Retrospective study of 86 consecutive patients who underwent ASO between September 2003 and December 2016.
- Analysis of indications for reoperation, reoperation techniques, and postoperative results.
- Follow-up included computed tomography (CT) angiography or coronary angiography.
Main Results:
- Seven reoperations were performed in 5 patients for coronary artery stenosis.
- Indications included severe stenosis confirmed by CT or coronary angiography, with or without symptoms.
- Unroofing and cut-back angioplasty had no complications; ostioplasty led to restenosis in 2 patients.
- The 5-year overall survival rate was 94.2%.
Conclusions:
- A standardized follow-up protocol with CT angiography or coronary angiography is essential after ASO.
- Unroofing and cut-back angioplasty demonstrate favorable outcomes for managing coronary artery stenosis post-ASO.
- These techniques may improve the management protocol for coronary artery stenosis after arterial switch operations.
Objectives:
Coronary artery stenosis after an arterial switch operation (ASO) leads to subsequent reoperation. Therefore, we investigated the indications for reoperation and the results of reoperation to suggest methods to improve our management protocol for coronary artery stenosis after an ASO.
Methods:
Between September 2003 and December 2016, 86 consecutive patients who underwent an ASO were included in the study. The indications for reoperation, reoperation techniques and postoperative results were investigated.
Results:
There were 4 in-hospital deaths (4.7%). One late death occurred during the median follow-up period of 59.6 months. The 5-year overall survival rate was 94.2%. Seven reoperations were performed in 5 patients due to coronary artery stenosis. The indications for reoperation were severe coronary artery stenosis confirmed by computed tomography (CT) angiography or coronary angiography with or without symptoms. Patients with a coronary artery between the great arteries or a high take-off coronary artery frequently required reoperation due to coronary artery stenosis. None of the patients who underwent unroofing or cut-back angioplasty experienced complications during the median follow-up period of 52.0 months. However, 2 patients who underwent ostioplasty required an additional reoperation due to coronary artery restenosis.
Conclusions:
A standardized follow-up protocol including CT angiography or coronary angiography after the ASO is required to address coronary artery stenosis. Good reoperation results were observed using the unroofing and cut-back angioplasty techniques.
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