Vol.3 - No.1

Long-term coronary artery outcome after arterial switch operation for transposition of the great arteries

By : baghaei

Keywords : Transposition of the great arteries • Arterial switch operation • Coronary arteries

Objective: To analyse the long-term patency of coronary ar-
teries after neonatal arterial switch operation (ASO). Meth-
ods: A retrospective study of the operative reports, follow-
up and postoperative catheterisation data of 119 patients,
who underwent the great arteries (TGA) repair since 1991,
has been carried out. Patient population: Among the 133
survivors of the 137 ASOs performed between 1991 and
2007, 119 patients have been studied by routine control car-
diac catheterisation and form the study population. Median
time between repair and the coronary angiography was 2.9
± 1.9 years. A comparison between the eight patients (6.7%
out of the entire study population), known to have postop-
erative coronary obstructions (group I) and the rest of the
cohort with angiographic normal coronary vessels (group
II) was performed by univariate analysis of variance and
logistic regression models. One patient had surgical plasty
of the left coronary main stem with subsequent percutane-
ous angioplasty, three patients had primary coronary stent
implantation and four patients had no further intervention at
all. In group I, all but one patient denied symptoms of chest
pain and echocardiography failed to show any difference
between the two groups in terms of left ventricular systolic
function (ejection fraction group I 61 ± 2% vs 62 ± 6% of
group II, p = 1.0). Results: The association of coronary ob-
struction with complex native coronary anatomy (Yacoub
type B to E) was evident at both univariate (62% of group
I vs 22% of group II, p = 0.04) and logistic regression (p =
0.007, odds ratio (OR) 8.1) models. The type of coronary
reimplantation (i.e., coronary buttons on punch vs trap-door
techniques) was similar between the two groups (punch re-
implantation in 25% of patients of group I vs 31% of group
II, p = 0.1) as was the relative position of the great vessels
(aorta anterior in 100% of patients of group I vs 96% of
group II; univariate, p = 0.1). Conclusions: The late out-
come in terms of survival and functional status after ASO
is excellent. Nevertheless, the risk of a clinically silent late
coronary artery obstruction of the reimplanted coronary ar-
teries warrants a prolonged follow-up protocol involving
invasive angiographic assessment.

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