Pediatric Applications of Surgical Patch Angioplasty of the Main Coronary Trunks

Abstract

Objectives: Obstruction of the main coronary trunks, although rare among the general pediatric population, remains an important complication of the arterial switch operation (ASO). Surgical patch angioplasty (SPA) is a technique whereby myocardial revascularization is achieved through direct ostial enlargement, restoring antegrade coronary flow, avoiding competitive flow, and preserving conduit material. This study investigates the indications, techniques, and outcomes of SPA in the pediatric population. Methods: A systematic literature review identified 15 studies incorporating 92 patients. The primary outcome of interest was 30-day mortality. Secondary outcomes included 30-day major adverse cardiac and cerebrovascular events, mortality at last follow-up, reintervention rate, symptomatic status, angiographic patency, and myocardial perfusion status at last follow-up. Results: The SPA was most frequently performed to treat ostial occlusion as a complication of the ASO (73.9%). Of the procedures, 77.2% involved the left main stem, 8.7% the left anterior descending artery, and 14.1% the right coronary artery. Saphenous vein was the commonest patch type (60.9%) followed by autologous pericardium (23.9%). Of the procedures, 96.7% were considered successful with an uneventful postoperative recovery. Overall hospital mortality was 2.2%. At a mean of 39 months of follow-up, 84.8% of the patients were asymptomatic, 51.1% of the repairs were angiographically patent, 9.8% had myocardial perfusion defects, and 6.5% required repeat revascularization. Conclusion: Current evidence suggests that SPA shows encouraging outcomes in a pediatric population and, with increasing experience, may provide a definitive solution to coronary artery occlusion.