Background The aim of this study was to evaluate long-term survival and freedom from coronary artery reintervention after the arterial switch operation (ASO). Methods and Results This single-center nationwide retrospective study included consecutive children who underwent ASO between 1990 and 2016 (n=605). Long-term outcomes were obtained by cross-mapping individual data with the National Death Registry and the National Registry of Cardiovascular Interventions for adults. A control group was randomly retrieved at a 1:10 ratio from the National Birth and Death Registries. Early mortality was 3.3% and late mortality was 1.7% during a median follow-up of 10 (interquartile range, 5-16) years. The probability of overall survival at 20 years after ASO was 94.9% compared with 99.5% in the background population (hazard ratio [HR] 15.6; 95% CI, 8.9-27.5, P<0.001). Independent multivariable predictors of worse survival were an intramural coronary artery (HR, 5.2; 95% CI, 1.8-15.2, P=0.002) and period of ASO 1990 to 1999 (HR, 4.6; 95% CI, 1.5-13.6, P<0.001). Fourteen patients (2.3%) required 16 coronary artery reoperations. Freedom from coronary artery reintervention at 20 years after ASO was 96%. The only independent multivariable predictor associated with a higher hazard for coronary artery reintervention was an intramural coronary artery (HR, 33.9; 95% CI, 11.8-97.5, P<0.001). Conclusions Long-term survival after ASO is excellent. Coronary artery reinterventions are rare. An intramural coronary artery was an independent predictor associated with a higher risk for coronary artery reintervention and death, regardless of the surgical period.

Children's Heart Centre 2nd Faculty of Medicine Charles University Prague and Motol University Hospital Prague Czech Republic

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Jatene AD, Fontes VF, Paulista PP, de Souza LC, Neger F, Galantier M, Souza JE. Successful anatomic correction of transposition of the great vessels. A preliminary report. Arq Bras Cardiol. 1975;28:461–464. PubMed

Fricke TA, D’Udekem Y, Richardson M, Thuys C, Dronavalli M, Ramsay JM, Wheaton G, Grigg LE, Brizard CP, Konstantinov IE. Outcomes of the arterial switch operation for transposition of the great arteries: 25 years of experience. Ann Thorac Surg. 2012;94:139–145. DOI: 10.1016/j.athoracsur.2012.03.019. PubMed DOI

Khairy P, Clair M, Fernandes SM, Blume ED, Powell AJ, Newburger JW, Landzberg MJ, Mayer JE. Cardiovascular outcomes after the arterial switch operation for D‐transposition of the great arteries. Circulation. 2013;127:331–339. DOI: 10.1161/CIRCULATIONAHA.112.135046. PubMed DOI

Moll M, Michalak KW, Sobczak‐Budlewska K, Moll JA, Kopala M, Szymczyk K, Dryżek P, Moll JJ. Coronary artery anomalies in patients with transposition of the great arteries and their impact on postoperative outcomes. Ann Thorac Surg. 2017;104:1620–1628. DOI: 10.1016/j.athoracsur.2017.03.078. PubMed DOI

Vida VL, Zanotto L, Zanotto L, Triglia LT, Bellanti E, Castaldi B, Padalino MA, Gasperetti A, Battista F, Varnier M, et al. Arterial switch operation for transposition of the great arteries: a single‐centre 32‐year experience. J Card Surg. 2019;34:1154–1161. DOI: 10.1111/jocs.14045. PubMed DOI

Fricke TA, Bell D, Daley M, D’Udekem Y, Brizard CP, Alphonso N, Konstantinov IE, D’Udekem Y, Brizard CP, Alphonso N, et al. The influence of coronary artery anatomy on mortality after the arterial switch operation. J Thorac Cardiovasc Surg. 2020;160:191–199.e1. DOI: 10.1016/j.jtcvs.2019.11.146. PubMed DOI

Fraser CD, Chacon‐Portillo MA, Well A, Zea‐Vera R, Binsalamah Z, Adachi I, Mery CM, Heinle JS. Twenty‐three‐year experience with the arterial switch operation: expectations and long‐term outcomes. Semin Thorac Cardiovasc Surg. 2020;32:292–299. DOI: 10.1053/j.semtcvs.2020.01.004. PubMed DOI

Pasquali SK, Hasselblad V, Li JS, Kong DF, Sanders SP. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries. Circulation. 2002;106:2575–2580. DOI: 10.1161/01.CIR.0000036745.19310.BB. PubMed DOI

Losay J, Touchot A, Serraf A, Litvinova A, Lambert V, Piot JD, Lacour‐Gayet F, Capderou A, Planche C. Late outcome after arterial switch operation for transposition of the great arteries. Circulation. 2001;104:I121–I126. DOI: 10.1161/hc37t1.094716. PubMed DOI

Metton O, Calvaruso D, Gaudin R, Mussa S, Raisky O, Bonnet D, Sidi D, Vouhé PR. Intramural coronary arteries and outcome of neonatal arterial switch operation. Eur J Cardiothorac Surg. 2010;37:1246–1253. DOI: 10.1016/j.ejcts.2009.12.042. PubMed DOI

Moll M, Moll JA, Moll JJ, Łubisz M, Michalak KW. Intramural coronary pattern in patients with transposition: incidence and impact on follow‐up. Eur J Cardiothorac Surg. 2020;58:145–152. DOI: 10.1093/ejcts/ezaa021. PubMed DOI

Vida VL, Zanotto L, Zanotto L, Stellin G, Padalino M, Sarris G, Protopapas E, Prospero C, Pizarro C, Woodford E, et al. Left‐sided reoperations after arterial switch operation: a European multicenter study. Ann Thorac Surg. 2017;104:899–906. DOI: 10.1016/j.athoracsur.2017.04.026. PubMed DOI

Lalezari S, Bruggemans EF, Blom NA, Hazekamp MG. Thirty‐year experience with the arterial switch operation. Ann Thorac Surg. 2011;92:973–979. DOI: 10.1016/j.athoracsur.2011.04.086. PubMed DOI

Angeli E, Raisky O, Bonnet D, Sidi D, Vouhé PR. Late reoperations after neonatal arterial switch operation for transposition of the great arteries. Eur J Cardiothorac Surg. 2008;34:32–36. DOI: 10.1016/j.ejcts.2008.04.007. PubMed DOI

Gittenberger‐de Groot AC, Koenraadt WMC, Bartelings MM, Bökenkamp R, DeRuiter MC, Hazekamp MG, Bogers AJJC, Quaegebeur JM, Schalij MJ, Vliegen HW, et al. Coding of coronary arterial origin and branching in congenital heart disease: the modified Leiden convention. J Thorac Cardiovasc Surg. 2018;156:2260–2269. DOI: 10.1016/j.jtcvs.2018.08.009. PubMed DOI

Fricke TA, Konstantinov IE. Translocation of intramural coronary artery in the arterial switch operation: divide and conquer? J Thorac Cardiovasc Surg. 2018;155:e131–e132. DOI: 10.1016/j.jtcvs.2017.12.108. PubMed DOI

Larsen SH, Olsen M, Emmertsen K, Hjortdal VE. Interventional treatment of patients with congenital heart disease: nationwide Danish experience over 39 years. J Am Coll Cardiol. 2017;69:2725–2732. DOI: 10.1016/j.jacc.2017.03.587. PubMed DOI

Spector LG, Menk JS, Knight JH, McCracken C, Thomas AS, Vinocur JM, Oster ME, St Louis JD, Moller JH, Kochilas L. Trends in long‐term mortality after congenital heart surgery. J Am Coll Cardiol. 2018;71:2434–2446. DOI: 10.1016/j.jacc.2018.03.491. PubMed DOI PMC

Raissadati A, Nieminen H, Sairanen H, Jokinen E. Outcomes after the Mustard, Senning and arterial switch operation for treatment of transposition of the great arteries in Finland: a nationwide 4‐decade perspective. Eur J Cardiothorac Surg. 2017;52:573–580. DOI: 10.1093/ejcts/ezx107. PubMed DOI

Fricke TA, Donaldson S, Schneider JR, Menahem S, d’Udekem Y, Brizard CP, Konstantinov IE. Outcomes of the arterial switch operation in patients with aortic arch obstruction. J Thorac Cardiovasc Surg. 2020;159:592–599. DOI: 10.1016/j.jtcvs.2019.07.103. PubMed DOI

Franklin RCG, Béland MJ, Colan SD, Walters HL, Aiello VD, Anderson RH, Bailliard F, Boris JR, Cohen MS, Gaynor JW, et al. Nomenclature for congenital and paediatric cardiac disease: the International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Iteration of the International Classification of Diseases (ICD‐11). Cardiol Young. 2017;27:1872–1938. DOI: 10.1017/S1047951117002244. PubMed DOI

Yacoub MH, Radley‐Smith R. Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction. Thorax. 1978;33:418–424. DOI: 10.1136/thx.33.4.418. PubMed DOI PMC

Planche C, Lacour‐Gayet F, Serraf A. Arterial switch. Pediatr Cardiol. 1998;19:297–307. DOI: 10.1007/s002469900313. PubMed DOI

Mishra A, Jain A, Hinduja M, Wadhawa V, Patel R, Vaidhya N, Rodricks D, Patel H. Transposition of great arteries with intramural coronary artery: experience with a modified surgical technique. Braz J Cardiovasc Surg. 2016;31:15–21. DOI: 10.5935/1678-9741.20160003. PubMed DOI PMC

Tomanek R, Angelini P. Embryology of coronary arteries and anatomy/pathophysiology of coronary anomalies. A comprehensive update. Int J Cardiol. 2019;281:28–34. DOI: 10.1016/j.ijcard.2018.11.135. PubMed DOI

Tian X, Hu T, Zhang H, He L, Huang X, Liu Q, Yu W, He L, Yang Z, Zhang Z, et al. Subepicardial endothelial cells invade the embryonic ventricle wall to form coronary arteries. Cell Res. 2013;23:1075–1090. DOI: 10.1038/cr.2013.83. PubMed DOI PMC

Théveniau‐Ruissy M, Pérez‐Pomares JM, Parisot P, Baldini A, Miquerol L, Kelly RG. Coronary stem development in wild‐type and Tbx1 null mouse hearts. Dev Dyn. 2016;245:445–459. DOI: 10.1002/dvdy.24380. PubMed DOI

Oda S, Nakano T, Sugiura J, Fusazaki N, Ishikawa S, Kado H. Twenty‐eight years’ experience of arterial switch operation for transposition of the great arteries in a single institution. Eur J Cardiothorac Surg. 2012;42:674–679. DOI: 10.1093/ejcts/ezs033. PubMed DOI

Legendre A, Losay J, Touchot‐Koné A, Serraf A, Belli E, Piot JD, Lambert V, Capderou A, Planche C. Coronary events after arterial switch operation for transposition of the great arteries. Circulation. 2003;108:186–190. DOI: 10.1161/01.cir.0000087902.67220.2b. PubMed DOI

Fricke TA, Bulstra AE, Naimo PS, Bullock A, Robertson T, D’Udekem Y, Brizard CP, Konstantinov IE. Excellent long‐term outcomes of the arterial switch operation in patients with intramural coronary arteries. Ann Thorac Surg. 2016;101:725–729. DOI: 10.1016/j.athoracsur.2015.08.090. PubMed DOI

Szymczyk K, Moll M, Sobczak‐Budlewska K, Moll JA, Stefańczyk L, Grzelak P, Moll JJ, Michalak KW. Usefulness of routine coronary CT angiography in patients with transposition of the great arteries after an arterial switch operation. Pediatr Cardiol. 2018;39:335–346. DOI: 10.1007/s00246-017-1761-z. PubMed DOI PMC

van Wijk SWH, van der Stelt F, ter Heide H, Schoof PH, Doevendans PAFM, Meijboom FJ, Breur JMPJ. Sudden death due to coronary artery lesions long‐term after the arterial switch operation: a systematic review. Can J Cardiol. 2017;33:1180–1187. DOI: 10.1016/j.cjca.2017.02.017. PubMed DOI