Al Anani Shada, Fughhi Ibtihaj, Taqatqa Anas, Elzein Chawki, Ilbawi Michel N, Polimenakos Anastasios C
Rush University Medical Center, Chicago, IL, USA.
Hope Advocate Children's Hospital, Oaklawn, IL, USA.
Pediatr Cardiol. 2017 Mar;38(3):513-524. doi: 10.1007/s00246-016-1543-z. Epub 2016 Dec 19.
Coronary artery anatomy represents a challenging and, often, determining predictor of outcome in an arterial switch operation (ASO). Impact of specific coronary artery variants, such as single, intramural and inverted, on time-related events following ASO, is, yet, to be determined. We sought to compare early and late outcomes within the group of nonstandard coronary artery variants. Patients who underwent ASO from January 1995 to October 2010 were reviewed. Patients with coronary artery variants other than L1Cx1R2 ("standard" by Leiden classification) were included. Patients with single, intramural and inverted coronary artery variants incorporated in group A. All other nonstandard coronary variants incorporated in group B. Demographics, perioperative variables, early and late outcomes were assessed. Of the 123 ASO, 24 patients (19.5%) with nonstandard coronary variant were studied. Thirteen were in group A and 11 in group B. There were two early deaths (1 in group A and 1 in group B) (p > 0.05). There is one death early after hospital discharge (group A). Mean follow-up was 59.4 ± 55.1 months. There was no structural coronary artery failure after hospital discharge following ASO. Freedom from any reintervention at 8 years was (78.3 ± 9.6%) (p 0.55) with no late neo-aortic or mitral valve intervention. ASO with single, intramural or inverted coronary artery course carries no added longitudinal risk for structural or flow impairment within the group of nonstandard coronary artery variants. There is an early hazard period with no late survival attrition. Aortic arch repair as part of staged strategy prior to ASO might influence early and late outcome.
冠状动脉解剖结构是动脉调转术（ASO）中一个具有挑战性且往往决定手术结果的预测因素。特定冠状动脉变异，如单支、壁内和倒置型变异，对ASO术后与时间相关事件的影响尚未确定。我们试图比较非标准冠状动脉变异组的早期和晚期结果。回顾了1995年1月至2010年10月接受ASO的患者。纳入了除L1Cx1R2（莱顿分类中的“标准”）以外的冠状动脉变异患者。单支、壁内和倒置冠状动脉变异患者归入A组。所有其他非标准冠状动脉变异患者归入B组。评估了人口统计学、围手术期变量、早期和晚期结果。在123例ASO中，研究了24例（19.5%）有非标准冠状动脉变异的患者。A组13例，B组11例。有2例早期死亡（A组1例，B组1例）（p>0.05）。有1例出院后早期死亡（A组）。平均随访时间为59.4±55.1个月。ASO术后出院后无冠状动脉结构功能衰竭。8年时无需再次干预的比例为（78.3±9.6%）（p 0.55），无晚期新主动脉瓣或二尖瓣干预。在非标准冠状动脉变异组中，单支、壁内或倒置冠状动脉走行的ASO不会增加结构或血流受损的长期风险。有一个早期危险期，无晚期生存损耗。作为ASO术前分期策略一部分的主动脉弓修复可能会影响早期和晚期结果。
