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 language | English |
|---|---|
| Pages (from-to) | 83-89 |
| Number of pages | 7 |
| Journal | European Journal of Cardio-thoracic Surgery |
| Volume | 52 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jul 1 2017 |
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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 journal › Article
}
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 -