Original articleCongenital heart surgeryExcellent Long-Term Outcomes of the Arterial Switch Operation in Patients With Intramural Coronary Arteries
Section snippets
Patients
The study was approved by the Royal Children’s Hospital Human Research Ethics Committee. Between May 1983 and January 2009, a total of 720 patients underwent an ASO at the Royal Children’s Hospital. An ASO was performed for TGA (n = 618), Taussig-Bing anomaly (TBA; n = 57), congenitally corrected TGA (n = 21), for atrial to ASO conversion (n = 15) and TGA with univentricular physiology (n = 9). All operation reports were reviewed and all patients with IMCA were identified. There were 28 (3.9%,
Early Outcomes
The intramural course involved the left main coronary artery in 24 (86%, 24 of 28) patients, the left anterior descending artery in 2 (7%, 2 of 28) patients, the right coronary artery in 1 (3.5%, 1 of 28) patient, and both left and right coronary arteries in 1 (3.5%, 1 of 28) patient (Fig 1). Our approach to the IMCA (Fig 2A) was detachment of the posterior commissure of the aortic (neopulmonary) valve in 25 (89%, 25 of 28; Fig 2B) patients and unroofing of the IMCA (Fig 2C) in 16 (57%, 16 of
Comment
Coronary transfer during the ASO in patients with IMCAs presents a surgical challenge. Few studies in the literature have looked specifically at the outcomes of this subgroup. A meta-analysis of 1,942 patients by Pasquali and colleagues [7] demonstrated that an IMCA had a 6.5-fold increased risk of mortality as compared to normal coronary anatomy. Metton and associates [6] reviewed 46 patients with IMCAs out of a cohort of 919 patients who underwent ASO between 1987 and 2008. They reported a
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