Single coronary artery and neonatal arterial switch operation: early and long-term outcomes.
OBJECTIVE
The presence of single coronary artery (CA) in the arterial switch operation (ASO) for neonatal treatment with transposition of the great arteries (TGA) has been reported to be an independent risk factor for early death after surgical repair and late reintervention. The study objective was to evaluate the mortality and the CA stenosis risk at early and long term in neonatal ASO for TGA and single CA.


METHODS
Between January 1987 and January 2010, 979 neonates underwent an ASO, of which 73 had a single CA (7.5% of all cohort): right ostium with posterior left CA loop was the most frequent pattern (63%), followed by left ostium with an anterior right CA loop (26%). Mean age at operation was 9.3 ± 5.7 days. Mean follow-up was 9.8 years (range: 1-20 years).


RESULTS
Eight patients (11%) died, 6 of coronary-related death. Overall, survival was 90.1 ± 1.9% at 1 year and 88.6% ± 3.8% at 2, 5, 10 and 15 years, respectively. Independent risk factor for mortality was associated surgery before 2001. Freedom from coronary events was 91.6 ± 3.3% at 1 year and 88.7 ± 3.8% at 5, 10 and 15 years respectively. No patients required late reintervention for CA surgery or angioplasty.


CONCLUSIONS
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.
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Sébastien
S
Gerelli
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Margaux
M
Pontailler
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Bruno
B
Rochas
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Emanuela
E
Angeli
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Mathieu
M
Van Steenberghe
Department of Pediatric Cardiology, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Damien
D
Bonnet
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Pascal
P
Vouhé
Department of Pediatric Cardiac Surgery, University Paris Descartes and Necker Sick Children Hospital, Paris, France.
Olivier
O
Raisky
D000015:Abnormalities, Multiple; D000069278:Arterial Switch Operation / Q000379:methods*; D017023:Coronary Angiography; D003330:Coronary Vessel Anomalies / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005602:France / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014188:Transposition of Great Vessels / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D014656:Vascular Surgical Procedures / Q000379:methods*
Congenital heart disease; Outcomes; Single coronary artery; Transposition of the great arteries