Intraoperative coronary revision but not coronary pattern is associated with mortality after arterial switch operation.
OBJECTIVE
We sought to determine differences in baseline characteristics and clinical outcomes in a consecutive series of patients undergoing arterial switch operation (ASO), assessing the effect of coronary anatomy on postoperative mortality, both overall and adjusted for surgical era.


METHODS
From January 2000 to May 2015, 283 consecutive patients underwent ASO for transposition of the great arteries. A total of 103 patients (36.4%) had an associated ventricular septal defect and 23 (8.1%) had an aortic arch obstruction. Coronary anomalies were present in 119 (42%) patients.


RESULTS
Overall survival was 93.0 ± 1% at 15 years (19 events). Intraoperative revision of the coronary anastomosis was required in 8 patients (2.8%) due to inability to wean from cardiopulmonary bypass (CPB) or post-CPB myocardial ischaemia. Surgical revision was neither related to the underlying coronary anatomy ( χ 2  =   0.681, P  = 0.4091) nor to the surgical era ( χ 2  =   0.682, P  = 0.4090). Univariable analysis suggested decreased mortality rate for infants who underwent surgery during 2008 or later ( P  = 0.01). In multivariable analysis, intraoperative coronary button revision was the only predictor of mortality [ P  < 0.001, hazard ratio (HR) 12.01, 95% confidence interval (CI) 3.85-37.49], whereas surgical era (before 2008) failed to achieve statistical significance ( P  = 0.057, HR 2.19, 95% CI 0.96-12.04).


CONCLUSIONS
In the recent era, unusual coronary patterns do not affect survival following ASO, whereas intraoperative coronary button revision is a predictor of mortality. Preventive strategies aimed towards intraoperative detection of impaired coronary perfusion are useful tools that might be considered for all patients in order to improve outcomes.
Department of Pediatric Cardiac Surgery, Bambino Gesú Children's Hospital IRCCS, Rome, Italy.
Matteo
M
Trezzi
Service of Neonatology and Pediatric Intensive Care, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
Angelo
A
Polito
Department of Pediatric Cardiac Surgery, Bambino Gesú Children's Hospital IRCCS, Rome, Italy.
Antonio
A
Albano
Department of Pediatric Cardiac Surgery, Bambino Gesú Children's Hospital IRCCS, Rome, Italy.
Sonia B
SB
Albanese
Department of Pediatric Cardiac Surgery, Bambino Gesú Children's Hospital IRCCS, Rome, Italy.
Enrico
E
Cetrano
Department of Pediatric Cardiac Surgery, Bambino Gesú Children's Hospital IRCCS, Rome, Italy.
Adriano
A
Carotti
D000069278:Arterial Switch Operation / Q000401:mortality*; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007432:Intraoperative Period; D007558:Italy / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome
Arterial switch operation; Coronary anatomy; Intraoperative coronary revision