Nine-Year Experience With the Arterial Switch Operation With Closed Coronary Transfer

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Coronary artery transfer is a critical component of the arterial switch operation (ASO) for transposition of the great arteries (TGA).
• Two main strategies exist: open transfer before neoaortic anastomosis and closed transfer after neoaortic anastomosis.
• This study evaluates outcomes of ASO utilizing exclusively closed coronary transfer.

Purpose of the Study:

• To report the outcomes of arterial switch operation (ASO) for transposition of the great arteries (TGA) using a single institution's experience with closed coronary transfer.
• To assess the impact of coronary anatomy complexity on surgical outcomes.
• To evaluate survival, reoperation rates, and aortic insufficiency following ASO with closed coronary transfer.

Main Methods:

• Retrospective analysis of 96 patients undergoing ASO for TGA between November 2006 and September 2015.
• Universal application of closed coronary transfer technique.
• Stratification of patients into simple versus complex coronary anatomy groups.
• Primary outcome: overall survival; secondary outcomes: reoperation-free survival, coronary reintervention, and aortic insufficiency.

Main Results:

• Overall survival was 97.4% and reoperation-free survival was 83.6% at a median follow-up of 5.8 years.
• Complex coronary anatomy (36% of patients) was associated with longer bypass and cross-clamp times but did not impact survival or reoperation-free survival.
• No coronary interventions were required post-ASO, and moderate/greater aortic insufficiency occurred in 2.1% at discharge and 1.5% at follow-up.

Conclusions:

• Closed coronary transfer during ASO for TGA yields excellent short- and midterm results.
• Coronary ischemic events are avoidable with this technique, irrespective of coronary anatomy complexity.
• The closed coronary transfer method demonstrates a low incidence of aortic valve injury and insufficiency.