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Impact of Coronary Artery Anatomy in Arterial Switch Operation: In-hospital and Post-discharge Outcomes

Shu-Yuan Wang1,2,3, Qing-Yu Zeng1,2,3, Li Zhang4,5,6,7

  • 1Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.

Current Medical Science
|May 18, 2022
PubMed

Insights

Arterial switch operation (ASO) for transposition of the great arteries (TGA) with coronary anomalies shows good outcomes. However, intramural coronary arteries and older age increase post-discharge mortality risk, emphasizing timely surgery.

Area of Science:

  • Cardiovascular Surgery
  • Pediatric Cardiology
  • Congenital Heart Disease

Background:

  • Arterial Switch Operation (ASO) is a standard treatment for transposition of the great arteries (TGA).
  • The impact of coronary artery anomalies on ASO outcomes is debated.
  • Taussig-Bing anomaly (TBA) presents unique surgical challenges.

Purpose of the Study:

  • To evaluate the influence of coronary artery anomalies on in-hospital and post-discharge outcomes after ASO.
  • To identify risk factors for mortality in TGA patients with TBA undergoing ASO.
  • To assess the long-term prognosis of ASO in complex pediatric cardiac cases.

Main Methods:

  • Retrospective review of 206 patients undergoing ASO between 2007 and 2019.
  • Analysis of in-hospital and post-discharge mortality, and long-term survival.
  • Statistical analysis to identify predictors of mortality, including coronary patterns and age at surgery.

Main Results:

  • Coronary anomalies were present in 41.7% of patients.
  • In-hospital mortality was associated with earlier surgical era and longer cardiopulmonary bypass time.
  • Intramural coronary artery and age >1 year at ASO were independent predictors of post-discharge mortality.

Conclusions:

  • ASO provides acceptable outcomes for TGA with coronary anomalies.
  • Intramural coronary artery is a significant risk factor for post-discharge mortality.
  • Timely surgical intervention within the first year of life improves midterm survival.
Abstract

Keywords:
complex coronary arterycongenital heart diseaseearly mortalitylate mortalitylearning curve

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