Single coronary artery and neonatal arterial switch operation: early and long-term outcomes†

Abstract

All coronary-related death occurred within the first 6 months after ASO, and all patients but 1 were operated before 2001. In our experience, it appears that a single CA is not any more a risk factor for early and late mortality after ASO for TGA. Mortality has drastically reduced since 2001 and is now close to that found in TGA with standard coronary patterns. The acquired experience shared between the surgeons and the institution offsets the undeniable surgical difficulty.

Arterial Switch Operation: Operative Approach and Outcomes

“…Such variation occurred in 16.5% of our patients [6]. A single coronary artery is the next most common abnormal pattern and occurs in 6% to 7% [6,12,40].…”

“…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.…”

Successful Late Recruitment of the Occluded Left Main Coronary Artery After Initial Arterial Switch Operation

“…1 The frequency of this complication depends on coronary anatomy and surgical technique, 2 but mostly on institutional experience. 1 –3 In the presence of postoperative diffuse left ventricular dysfunction and low EF early after an arterial switch operation, the decision regarding immediate reoperation and coronary anastomosis revision should be made. 4 This allows avoidance of sustained myocardial necrosis and increases the chance for successful postoperative recovery.…”

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.…”