Influence of coronary anatomy and reimplantation on the long-term outcome of the arterial switch✩

Abstract

Abnormal coronary anatomy was not a determinant of outcome in our study. Surgical coronary obstruction is independent of original anatomy. It can be almost silent and is potentially fatal. Follow-up angiography must be considered in all patients after the arterial switch operation.

Coronary Artery Pattern and Outcome of Arterial Switch Operation for Transposition of the Great Arteries

“…[11][12][13][14][15][16][17][18][19] Each study represents the experience of a single center over a time period of 3 to 22 years. The sample sizes ranged from 66 to 470 patients, for a total of 1942 patients in our combined analysis.…”

“…On the basis of prior studies, as well as surgical techniques and complications, we hypothesized that certain coronary patterns would be associated with similar mortality rates and grouped them for analysis [11][12][13][14][15][16][17][18][19] (Figure 1). The first group included coronary arteries that looped around the great vessels: either a portion or all of the LCA looped behind the pulmonary artery (circumflex from right coronary artery [RCA], single RCA), the RCA looped anterior to the aorta (single LCA), or both (inverted, inverted RCA and circumflex).…”

“…13,14,20 A multicenter study was excluded in favor of studies from participating institutions that, taken together, provided data on more patients over a longer time period. 14 -16,21 After these criteria were applied, the present study included 9 independent case series [11][12][13][14][15][16][17][18][19] (Table 1).…”

“…Because the study by Pretre et al 11 reported data for both subgroups, data from this study were split. The study by Hutter et al 12 reported over a 22-year period that spanned both eras and was excluded. ORs were calculated and combined for studies conducted before 1992 and during 1992 or later.…”

“…Some have indicated that coronary patterns such as a retropulmonary looping left coronary artery (LCA) or an intramural coronary artery predict increased morbidity and mortality, whereas others have not. [11][12][13][14][15][16][17][18][19] In general, these studies have been limited by lack of statistical power to detect the impact of coronary anatomy on outcome. For example, in a 1999 study, Blume et al 13 reported variant coronary patterns were not associated with increased mortality.…”