Journal of Pediatric Cardiology and Cardiac Surgery

Online ISSN: 2433-1783 Print ISSN: 2433-2720
Japanese Society of Pediatric Cardiology and Cardiac Surgery
Japanese Society of Pediatric Cardiology and Cardiac Surgery Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of Pediatric Cardiology and Cardiac Surgery 8(1): 8-14 (2024)


Coronary Artery Complications Following Arterial Switch Operation for Transposition of the Great Arteries: Evaluation of Surgical Managements and Proposal for a New Guideline

1Japan Cardiovascular Research Foundation, Director ◇ Osaka, Japan

2Japan National Cerebral and Cardiovascular Center, President Emeritus ◇ Osaka, Japan

発行日:2024年2月29日Published: February 29, 2024

Coronary artery stenosis or occlusion following coronary transfer procedures in congenital heart surgery is a rare but serious complication that often leads to severe heart failure. This complication often needs extracorporeal membrane oxygenation support in the early stage and is associated with sudden death or the need for heart transplantation later after surgery. The complication is particularly important in an arterial switch operation for transposition of the great arteries (TGA), which is performed in newborns and infants with low body weight. Additionally, TGA is often associated with various anatomical coronary abnormalities. Two surgical procedures have been used to manage this complication: surgical redo of coronary ostial anastomosis, often with autologous tissue patch enlargement (SOAP) and pediatric coronary artery bypass surgery using the internal thoracic artery (PCABS-ITA). Both methods have relative advantages and disadvantages but early surgical survival results are equivalent. Based on various database analyses, I currently consider SOAP as I(C) and PCABS-ITA as IIa(C) for a rescue operation in which coronary obstruction is due to technical errors or mechanical compression, kinking, and/or stretching. For late coronary complications in which fibroproliferative obstruction is the main cause, I recommend PCABS-ITA as I(C) and SOAP as IIa(C). In addition, tight stenosis (>90%) or total obstruction extending into the bifurcation of the left main trunk favors PCABS-ITA, whereas localized left main stenosis of a less severe degree favors SOAP. Careful follow-up and long-term results are important. Because coronary obstruction is a serious but rare complication, analysis of long-term data is essential.

Key words: coronary transfer; arterial switch operation; coronary obstruction; surgical ostial angioplasty; pediatric coronary bypass surgery

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