Coronary Artery Anomalies in Patients With Transposition of the Great Arteries and Their Impact on Postoperative Outcomes

Abstract

With the exception of patients whose circumflex artery branches off of the right coronary artery, an anomaly that clearly has no effect on postoperative follow-up, patients with unusual coronary patterns are at higher risk for adverse postoperative outcomes than patients with normal coronary anatomy and must be monitored carefully.

Arterial Switch Operation: Operative Approach and Outcomes

“…Anomalous coronary arteries are common in patients undergoing the ASO, making up approximately one-third of children operated [6,38,39]. The most common variant of coronary anatomy pattern is the left anterior descending artery arising from sinus 1 and right coronary and left circumflex coronary arteries arising from sinus 2 [6,12,38,39].…”

“…There are conflicting data in the literature on whether abnormal coronary artery pattern is a risk factor for death [6,[38][39][40][41][42][43][44][45][46][47][48]. The meta-analysis by Pasquali and colleagues [41] of 1942 patients reported that any variant of coronary artery anatomy doubled the risk of death compared with normal coronary anatomy.…”

Commentary: The arterial switch operation: Is it still all about the coronaries?

“…Large studies from the 1980s and 1990s described a greater mortality for patients with single and intramural coronaries. 4,5 Despite some recent studies still showing a greater mortality in patients with a single coronary, 6 others have concluded that coronary abnormalities are no longer a risk factor for mortality, 7 presumably due to increased surgical experience.…”

Invited Commentary

“…

The article by Moll and colleagues [1] reports the results of a retrospective review of 715 patients undergoing arterial switch operation at their institution over a 26-year period. The main stated findings of the article were that:(1) complex coronary anomalies (CCAs) have an important influence on the reintervention rate and the postoperative coronary event rate among their patients; (2) a common variant, circumflex coronary artery (Cx) from the right coronary artery (1LAD2RCALCx), does not appear to have an effect on the clinical outcomes studied; and (3) complex cardiac anomalies, which were included in the population, were a risk factor for worse outcome.There are two integrated messages from their article, the first of which is unstated directly: that the trap-door technique could mitigate the effects of some of these anomalies.

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“…The article by Moll and colleagues [1] reports the results of a retrospective review of 715 patients undergoing arterial switch operation at their institution over a 26-year period. The main stated findings of the article were that:…”