Article Text

  1. M. Berkman,
  2. H. Laks,
  3. V. Allada,
  4. J. Odim
  1. Division of Cardiothoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA


Objective To determine the short- and midterm outcome of the arterial switch operation (ASO) in infants with normal and abnormal coronary artery patterns.

Methods A retrospective analysis was conducted of the experience with the ASO at one institution over the span of 20 years from 1985 through 2005. Two hundred eight consecutive ASOs were performed by the same surgeon for transposition and double-outlet ventricle complexes. Of the 208 coronary artery patterns, 159 (76%) and 49 (24%) were normal and abnormal, respectively. These were classified into 4 groups: Type I (n = 159, 76%) had the typical dual arrangement (1AD, Cx; 2R), Type II (n = 26, 13%) had a dual system other than the typical, Type III (n = 11, 5%) had a single ostium coronary system, and Type IV (n = 12, 6%) included any pattern that had an intramural coronary course or commissural take-off. The primary end points were short- and long-term mortality.

Results There was no difference at operation in weight, gender, preoperative inotropic support, presence of VSD and RVOTO between the normal and abnormal groups. There were a total of 16/208 deaths over 20 years (7.7%), with a mean follow-up time of 7.2 years (range 3 months to 19 years). There was no significant difference in the early mortality rate for the normal coronary patterns, 6 out of 159 (3.7%) and the abnormal coronary patterns, 3 out of 49 (6.1%) (p = .29). Similarly, there was no difference in late deaths in the normal, 4 (2.5%), and abnormal, 3 (6.1%), groups (p = .12).

Conclusions The existence of abnormal coronary patterns is not a risk factor for early or late mortality after ASO. The impact on late ventricular function awaits determination.

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