Congenital: Transposition
The influence of coronary artery anatomy on mortality after the arterial switch operation

Read at the 99th Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, May 4-7, 2019.
https://doi.org/10.1016/j.jtcvs.2019.11.146Get rights and content
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Abstract

Objective

We sought to determine the influence of coronary artery anatomy on mortality in more than 1000 children undergoing the arterial switch operation.

Methods

All patients who underwent an arterial switch operation were identified from 2 hospital databases and reviewed retrospectively. Coronary anatomy was recorded from operative reports using the Leiden classification.

Results

An arterial switch operation was performed in 1033 children between 1983 and 2013. Coronary anatomy was normal in 697 patients (67%). The most common type of anomalous coronary anatomy was the circumflex coronary artery arising from sinus 2 (in 152 patients [15%]). Forty-seven patients (4.5%) had all coronary arteries arising from a single sinus. Of these 47 patients, 34 patients (3.3%) had a true single coronary artery. Fifty-two patients (5.0%) had an intramural coronary artery. Overall early mortality was 3.3% (34 out of 1033 patients) over the 30-year period. Early mortality was 3.0% (21 out of 697) for patients with normal coronary anatomy and 3.9% (13 out of 336) for any type of anomalous coronary anatomy. Early mortality was 3.3% (5 out of 152) for patients with the circumflex coronary artery arising from sinus 2, 6.4% (3 out of 47) for patients with all coronary arteries arising from a single sinus, and 5.9% (2 out of 34) for patients with a true single coronary artery. Early mortality for patients with intramural coronaries was 1.9% (1 out of 52). No coronary pattern was found to be a risk factor for mortality.

Conclusions

Patients with anomalous coronary artery anatomy had higher rates of early mortality after the arterial switch operation but this was not statistically significant. Coronary artery reoperations were rare.

Key Words

arterial switch operation
anomalous coronary artery

Abbreviations and Acronyms

ASO
arterial switch operation
Cx
circumflex
ECMO
extracorporeal membrane oxygenation
MCS
mechanical circulatory support
LAD
left anterior descending
NYHA
New York Heart Association
RCA
right coronary artery
TGA
transposition of the great arteries
TGA-IVS
transposition of the great arteries with an intact ventricular septum without aortic arch obstruction
TGA-VSD
transposition of the great arteries with a ventricular septal defect without aortic arch obstruction

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Supported by the Victorian Government's Operational Infrastructure Support Program in Australia. Dr Fricke is a recipient of a postgraduate scholarship from the Australian National Health and Medical Research Council (No. 1134203). Dr d'Udekem is an Australian National Health and Medical Research Council Clinician Practitioner Fellow (No. 1082186).