CAN CORONARY ANATOMY INFLUENCE THE OUTCOME OF ARTERIAL SWITCH OPERATION FOR TRANSPOSITION OF THE GREAT ARTERIES?

Background and Aim: ASO is choice procedure for TGA correction. The transfer of coronary artery origins is the crucial part of this operation, especially in presence of coronary anomalies that increase complexity and have an effect on postoperative outcomes. The study’s aim is to analyze the relationship between coronary anomalies and postoperative outcome. Methods: We retrospectively reviewed 233 pts who underwent ASO from 01/2001 to 10/2023. At operation, median age was 18,28±49,85 days and median weight 3235,97±729,99 gr. The study included TGA simple (n=158) and complex (n=75). Coronary anatomy is classified according to the Yacoub classification. The surgical technique used for coronary transplantation is trap-door technique, sometimes button technique also. The median follow-up is 8,5±6,6 years. Results: 86 (36,9%) patients had coronary anomalies. REDO was performed in 31 (13,5%) pts, not related to the coronary arteries. 5 (2,6%) pts had a coronary stenosis, 1 required PCI. There were 4 (1.9%) in-hospital deaths (no post-discharge deaths). Overall survival was 98,1%, 97.9% and 96,8% at 1, 5 and 10 years. Coronary anatomy didn’t influence early postoperative mortality, instead intramural coronary artery and button technique coronary transplantation significantly increased mortality. Conclusions: ASO remains the choice procedure also for TGA with coronary anomalies with excellent in-hospital and post-discharge outcomes in terms of overall survival and freedom from reoperation. Improvements in preoperative imaging and increased surgeon experience decrease mortality associated with abnormal coronary patterns. Furthermore, pts with intramural coronary artery have higher risk for adverse postoperative outcome and must be monitored carefully.