Long‐Term Survival and Freedom From Coronary Artery Reintervention After Arterial Switch Operation for Transposition of the Great Arteries: A Population‐Based Nationwide Study

Abstract

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.