Objectives: The introduction of the arterial switch operation (ASO) for repair of transposition
of the great arteries (TGA) has transformed survival with this condition. However,
coronary complications resulting from coronary transfer with reimplantation into the
neo-aortic root remain a concern. We aimed to evaluate coronary complications in this
national cohort of TGA patients.
Methods: Registry search of the German Network for Congenital Heart Disease.
Results: At the time of analysis, 1,737 TGA patients were included in the networks registry,
of whom 871 patients had undergone the ASO. CA complications were reported on in only
13 (1.5%) patients: two presented with myocardial infarction; five were diagnosed
with CA occlusion and another 6 with coronary stenosis. Of those, four patients underwent
CAVB surgery, in 3 the CA was re-implanted and another 3 underwent coronary angioplasty
with stent placement. In 3 patients no revascularization was undertaken.
It is noteworthy, that 4 of the 13 patients with CA complications had an unusual coronary
anatomy (common origin, double ostium, intramural course of the CA, right CA from
left sinus and hypoplastic left CA from right sinus), 2 of whom died 2.2 and 14.4
years after ASO. These patients did not undergo any revascularization procedure.
Two of the 11 patients who were still alive after 19.8 years of follow-up developed
ventricular tachycardia resulting in ICD implantation 16 and 19 years following their
ASO.
Conclusion: Albeit the technical challenge of reimplantation of the CA during the ASO, late CA
complications appear to be rare. The true incidence, however, remains unclear as this
complication might be underdiagnosed and underreported. Survival with this complication
seems guarded. Particular caution at follow-up should be taken in patients with an
unusual CA anatomy pattern. Coronary complications are associated with adverse outcomes
and routine coronary angiography after the ASO could be considered, particularly in
patients with unusual coronary anatomy.
