Intraoperative coronary revision but not coronary pattern is associated with mortality after arterial switch operation

Matteo Trezzi, Angelo Polito, Antonio Albano, Sonia B. Albanese, Enrico Cetrano, Adriano Carotti

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: 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 (χ2=0.681, P=0.4091) nor to the surgical era (χ2=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.

Original languageEnglish
Pages (from-to)83-89
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume52
Issue number1
DOIs
Publication statusPublished - Jul 1 2017

Fingerprint

Mortality
Cardiopulmonary Bypass
Anatomy
Confidence Intervals
Transposition of Great Vessels
Survival
Ventricular Heart Septal Defects
Thoracic Aorta
Reoperation
Myocardial Ischemia
Arterial Switch Operation
Perfusion

Keywords

  • Arterial switch operation
  • Coronary anatomy
  • Intraoperative coronary revision

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Intraoperative coronary revision but not coronary pattern is associated with mortality after arterial switch operation. / Trezzi, Matteo; Polito, Angelo; Albano, Antonio; Albanese, Sonia B.; Cetrano, Enrico; Carotti, Adriano.

In: European Journal of Cardio-thoracic Surgery, Vol. 52, No. 1, 01.07.2017, p. 83-89.

Research output: Contribution to journalArticle

@article{db760a98ecbb417986db038cb214bbbc,
title = "Intraoperative coronary revision but not coronary pattern is associated with mortality after arterial switch operation",
abstract = "OBJECTIVES: 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 (χ2=0.681, P=0.4091) nor to the surgical era (χ2=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.",
keywords = "Arterial switch operation, Coronary anatomy, Intraoperative coronary revision",
author = "Matteo Trezzi and Angelo Polito and Antonio Albano and Albanese, {Sonia B.} and Enrico Cetrano and Adriano Carotti",
year = "2017",
month = "7",
day = "1",
doi = "10.1093/ejcts/ezx055",
language = "English",
volume = "52",
pages = "83--89",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "European Association for Cardio-Thoracic Surgery",
number = "1",

}

TY - JOUR

T1 - Intraoperative coronary revision but not coronary pattern is associated with mortality after arterial switch operation

AU - Trezzi, Matteo

AU - Polito, Angelo

AU - Albano, Antonio

AU - Albanese, Sonia B.

AU - Cetrano, Enrico

AU - Carotti, Adriano

PY - 2017/7/1

Y1 - 2017/7/1

N2 - OBJECTIVES: 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 (χ2=0.681, P=0.4091) nor to the surgical era (χ2=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.

AB - OBJECTIVES: 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 (χ2=0.681, P=0.4091) nor to the surgical era (χ2=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.

KW - Arterial switch operation

KW - Coronary anatomy

KW - Intraoperative coronary revision

UR - http://www.scopus.com/inward/record.url?scp=85021736957&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85021736957&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezx055

DO - 10.1093/ejcts/ezx055

M3 - Article

AN - SCOPUS:85021736957

VL - 52

SP - 83

EP - 89

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 1

ER -