van Wijk Sebastiaan W H, van der Stelt Femke, Ter Heide Henriëtte, Schoof Paul H, Doevendans Pieter A F M, Meijboom Folkert J, Breur Johannes M P J
Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Can J Cardiol. 2017 Sep;33(9):1180-1187. doi: 10.1016/j.cjca.2017.02.017. Epub 2017 Apr 8.
The arterial switch operation (ASO) is the preferred procedure for children with dextrotransposition of the great arteries or Taussig-Bing anomaly. Short- as well as long-term outcome of ASO are excellent, but coronary artery stenoses are reported as a common long-term complication. It has been hypothesized that these might result in sudden cardiac death late after ASO.
A systematic search of PubMed and EMBASE was conducted to evaluate sudden cardiac death because of coronary complications late after ASO. Data on patients surviving ≥ 5 years post-ASO were collected from selected studies, corrected for duplicate data, and analyzed.
After duplicate data correction 52 studies remained for data analysis. Among the 8798 survivors with follow-up, 27 patients died ≥ 5 years post-ASO (0.3%). Of these patients, 10 were known with relevant residual lesions. Five late deaths were sudden, possibly from a cardiac cause. None of the late sudden deaths were confirmed to be coronary-related.
Sudden cardiac death in asymptomatic patients as a result of coronary artery stenosis or occlusion is extremely rare, with 5 possible cases and no proven cases of coronary artery-related sudden cardiac death in 8798 patients with 66,450 patient follow-up years. Therefore, routine coronary imaging of asymptomatic, single-stage ASO patients is not justified.
动脉调转术（ASO）是患有大动脉右位转位或陶西格-宾氏畸形的儿童的首选手术。ASO的短期和长期效果都很好，但冠状动脉狭窄被报道为常见的长期并发症。据推测，这些可能会导致ASO术后晚期的心源性猝死。
对PubMed和EMBASE进行系统检索，以评估ASO术后晚期因冠状动脉并发症导致的心源性猝死。从选定的研究中收集ASO术后存活≥5年的患者的数据，校正重复数据后进行分析。
校正重复数据后，剩余52项研究用于数据分析。在8798名有随访的幸存者中，27例在ASO术后≥5年死亡（0.3%）。在这些患者中，10例已知有相关残余病变。5例晚期死亡为猝死，可能由心脏原因引起。晚期猝死均未被证实与冠状动脉相关。
在8798例患者、66450患者随访年中，因冠状动脉狭窄或闭塞导致无症状患者的心源性猝死极为罕见，有5例可能病例，但无经证实的冠状动脉相关心源性猝死病例。因此，对无症状的单期ASO患者进行常规冠状动脉成像没有依据。
