Abstract：
OBJECTIVE: The influence of the coronary artery anatomy on the prognosis of patients receiving an arterial switch operation (ASO) is currently controversial, and the risk factors for this operation may change in more complicated patients. This study aimed to investigate the influence of coronary artery anomalies on the in-hospital and post-discharge outcomes of ASO in patients with transposition of the great arteries (TGA) and Taussig-Bing anomaly (TBA).
METHODS: We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019. The median age at operation was 33 [interquartile range (IQR): 20-71] days. Median follow-up time was 7.2 years (IQR: 4.0-10.3 years).
RESULTS: Coronary anomalies were present in 86 patients (41.7%), with 9 (4.4%) of them having a single coronary artery. Additional coronary features included intramural courses in 5 (2.4%) patients, ostial stenosis in 1 (0.5%) patient, and accessory coronary artery orifices in 5 (2.4%) patients. There were 32 (15.5%) in-hospital deaths and 8 (4.6%) post-discharge deaths, yielding an overall survival of 81.3%, 80.7% and 79.9% at 1, 5 and 10 years, respectively. Mortality due to ASO has been drastically decreased since 2013. Patients with a single coronary artery had higher rate of in-hospital mortality, but this finding was not statistically significant. The earlier surgical era (OR: 2.756) and a longer cardiopulmonary bypass time (OR: 2.336) were significantly associated with in-hospital mortality, while coronary patterns were not. An intramural coronary artery (HR: 10.034) and a patient age of older than 1 year at the time of ASO (HR: 9.706) were independent predictors of post-discharge mortality.
CONCLUSIONS: ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation. However, intramural coronary artery is an independent risk factor for post-discharge mortality. Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.
METHODS: We retrospectively reviewed 206 patients who underwent ASO from January 2007 to December 2019. The median age at operation was 33 [interquartile range (IQR): 20-71] days. Median follow-up time was 7.2 years (IQR: 4.0-10.3 years).
RESULTS: Coronary anomalies were present in 86 patients (41.7%), with 9 (4.4%) of them having a single coronary artery. Additional coronary features included intramural courses in 5 (2.4%) patients, ostial stenosis in 1 (0.5%) patient, and accessory coronary artery orifices in 5 (2.4%) patients. There were 32 (15.5%) in-hospital deaths and 8 (4.6%) post-discharge deaths, yielding an overall survival of 81.3%, 80.7% and 79.9% at 1, 5 and 10 years, respectively. Mortality due to ASO has been drastically decreased since 2013. Patients with a single coronary artery had higher rate of in-hospital mortality, but this finding was not statistically significant. The earlier surgical era (OR: 2.756) and a longer cardiopulmonary bypass time (OR: 2.336) were significantly associated with in-hospital mortality, while coronary patterns were not. An intramural coronary artery (HR: 10.034) and a patient age of older than 1 year at the time of ASO (HR: 9.706) were independent predictors of post-discharge mortality.
CONCLUSIONS: ASO remains the procedure of choice for TGA with coronary anomalies with acceptable in-hospital and post-discharge outcomes in terms of overall survival and freedom of reoperation. However, intramural coronary artery is an independent risk factor for post-discharge mortality. Timely surgery within the 1st year of life helps improve overall midterm survival of ASO.
摘要：
目的：冠状动脉解剖对接受动脉转换手术（ASO）的患者预后的影响目前存在争议，在更复杂的患者中，这种手术的危险因素可能会发生变化。本研究旨在探讨冠状动脉异常对大动脉转位（TGA）和Taussig-Bing异常（TBA）患者ASO院内和出院后预后的影响。
方法：我们回顾性分析了2007年1月至2019年12月接受ASO的206例患者。手术年龄中位数为33[四分位距（IQR）：20-71]天。中位随访时间为7.2年（IQR：4.0-10.3年）。
结果：86例患者（41.7%）出现冠状动脉异常，其中9人（4.4%）有单冠状动脉。其他冠状动脉特征包括5例（2.4％）患者的壁内病程，1例（0.5%）患者口狭窄，5例（2.4％）患者的副冠状动脉孔。有32例(15.5%)住院死亡,8例(4.6%)出院后死亡,总生存率为81.3%，1年、5年和10年分别为80.7%和79.9%，分别。自2013年以来，ASO导致的死亡率急剧下降。单支冠状动脉患者的院内死亡率较高，但这一发现没有统计学意义。较早的手术时间（OR：2.756）和较长的体外循环时间（OR：2.336）与住院死亡率显着相关，而冠状动脉模式没有。壁冠状动脉（HR：10.034）和ASO时年龄大于1岁的患者（HR：9.706）是出院后死亡率的独立预测因素。
结论：ASO仍然是有冠状动脉异常的TGA的首选方法，在总体生存率和再次手术的自由方面具有可接受的院内和出院后结局。然而,壁冠状动脉是出院后死亡的独立危险因素。在生命的第一年内及时手术有助于提高ASO的总体中期生存率。
方法：我们回顾性分析了2007年1月至2019年12月接受ASO的206例患者。手术年龄中位数为33[四分位距（IQR）：20-71]天。中位随访时间为7.2年（IQR：4.0-10.3年）。
结果：86例患者（41.7%）出现冠状动脉异常，其中9人（4.4%）有单冠状动脉。其他冠状动脉特征包括5例（2.4％）患者的壁内病程，1例（0.5%）患者口狭窄，5例（2.4％）患者的副冠状动脉孔。有32例(15.5%)住院死亡,8例(4.6%)出院后死亡,总生存率为81.3%，1年、5年和10年分别为80.7%和79.9%，分别。自2013年以来，ASO导致的死亡率急剧下降。单支冠状动脉患者的院内死亡率较高，但这一发现没有统计学意义。较早的手术时间（OR：2.756）和较长的体外循环时间（OR：2.336）与住院死亡率显着相关，而冠状动脉模式没有。壁冠状动脉（HR：10.034）和ASO时年龄大于1岁的患者（HR：9.706）是出院后死亡率的独立预测因素。
结论：ASO仍然是有冠状动脉异常的TGA的首选方法，在总体生存率和再次手术的自由方面具有可接受的院内和出院后结局。然而,壁冠状动脉是出院后死亡的独立危险因素。在生命的第一年内及时手术有助于提高ASO的总体中期生存率。
