Neonatal arterial switch operation: coronary artery patterns and coronary events

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease Management
• Cardiovascular Outcomes Research

Background:

• Neonatal arterial switch operation (ASO) is a critical procedure for treating transposition of the great arteries.
• Assessing long-term outcomes, particularly coronary events, after ASO is essential for patient management.
• Identifying risk factors for mortality and morbidity post-ASO can guide surgical decision-making.

Purpose of the Study:

• To determine the incidence of coronary events following neonatal arterial switch.
• To identify potential risk factors associated with death and coronary events after ASO.
• To evaluate the mid-term results and operative risks of ASO in a large cohort.

Main Methods:

• Analysis of 236 consecutive arterial switch operations performed by a single surgeon.
• Inclusion of associated procedures such as ventricular septal defect closure and aortic arch repair.
• Statistical analysis of patient, procedural, support technique, and experience variables to identify risk factors.

Main Results:

• Overall survival at 5 years was 92%, with 19 deaths (8%).
• Risk factors for death included low birth weight, right ventricular hypoplasia, aortic arch obstruction, and specific coronary artery patterns.
• Coronary events occurred in 11% of patients, with risk factors including coronary artery origins and courses relative to the great arteries.

Conclusions:

• Neonatal arterial switch operation generally has low operative risk and excellent mid-term outcomes.
• Certain patient subsets and coronary patterns are associated with increased operative risk and risk of coronary events.
• Further surgical experience may lead to improved outcomes and reduced complication rates.