Outcomes of coronary artery obstructions after the arterial switch operation for transposition of the great arteries

Léa Linglart; Sophie Malekzadeh-Milani; Régis Gaudin; Olivier Raisky; Damien Bonnet

doi:10.1016/j.jtcvs.2023.11.029

Outcomes of coronary artery obstructions after the arterial switch operation for transposition of the great arteries

J Thorac Cardiovasc Surg. 2023 Nov 23:S0022-5223(23)01105-4. doi: 10.1016/j.jtcvs.2023.11.029. Online ahead of print.

Authors

Léa Linglart¹, Sophie Malekzadeh-Milani², Régis Gaudin², Olivier Raisky², Damien Bonnet³

Affiliations

¹ Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France; Sorbonne Université, Paris, France.
² Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France.
³ Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Hôpital Universitaire Necker-Enfants Malades, AP-HP, Paris, France; Université de Paris Cité, Paris, France. Electronic address: damien.bonnet1@gmail.com.

PMID: 38006998
DOI: 10.1016/j.jtcvs.2023.11.029

Abstract

Objective: Coronary obstruction is a rare but common complication of the arterial switch operation for transposition of the great arteries. The majority of patients remain asymptomatic and no risk factors allow targeting for reinforced surveillance. We aim to review the natural history of patients diagnosed with coronary obstruction after arterial switch operation for transposition of the great arteries and occurrence of coronary-related outcomes.

Methods: We retrospectively reviewed medical records of the 102 patients diagnosed with coronary obstruction after arterial switch operation for transposition of the great arteries in our institution from 1981 to 2022. Outcomes were anti-ischemic treatment introduction, revascularization (surgical or percutaneous angioplasty), and death; investigations that motivated revascularization were also reviewed.

Results: Twenty-eight out of 102 patients presented with myocardial ischemia during the immediate postoperative phase, 31 were diagnosed when symptomatic, and 43 were identified at the presymptomatic stage, according to our screening policy in preschool-aged children. Stenosis-related event occurrence was, respectively, 29 out of 31 and 32 out of 43 in the latter 2 subgroups. Coronary-related mortality reached 10% in patients diagnosed when symptomatic; no patients died in the presymptomatic subgroup. Of the 28 low-risk patients with no signs of ischemia at diagnosis, 10 developed obstruction warranting reintervention during follow-up. Revascularization was motivated by appearance of symptoms in patients with severe stenosis in normal coronary dispositions, and by clinical symptoms or documented silent ischemia in abnormal coronary patterns.

Conclusions: Occurrence of stenosis-related events remains significant in patients after arterial switch operation, underlining the importance of early diagnosis for timely intervention. Initial anatomical evaluation identifies stenotic and at-risk patients; this will require periodical function testing. Follow-up modalities can be tailored to a patient's individual anatomic characteristics.

Keywords: arterial switch; coronary event; coronary stenosis; screening; transposition of great arteries.