Coronary Artery Morbidity and Assessment Practice in Childhood and Adolescence after Arterial Switch operation (ASO) in Germany: An Analysis from the OptAHF Study Investigators

Background: Arterial switch operation (ASO) is the treatment of choice in neonates with transposition of the great arteries (d-TGA). While short and mid-term outcome is encouraging, limited data for long-term outcome exist. Many patients require re-interventions or present with relevant cardiac sequelae. While in adult patients, periodic surveillance coronary artery angiography is advocated by some, pediatric data supporting this practice are sparse. We aimed to assess the current clinical practice by using a nationwide administrative database.

Method: Analysis of a large nationwide Barmer health insurance database including >9.1 million members from 2005 to 2021, identifying patients with a diagnosis of dTGA after ASO, as well as patients with ccTGA (congenitally corrected TGA) with double switch operation.

Results: In total, we identified 275 patients (74% males), 269 with a diagnosis of dTGA and 6 patients (50% males) with ccTGA. Mean age at ASO in dTGA patients was 16 days, while age at double switch operation was 167 days.

Of the 189 patients who continued to be registered within the BARMER health insurance company, there have been 11 documented deaths (9 in patients with d-TGA at a mean age of 1.1 years and 2 in patients with ccTGA at 3.9 years of age). A total of 178 patients (94%) were still alive at the end of follow-up.

During this time, 80 diagnostic coronary angiographies were performed in 60 children postoperatively (11 within <6 months, 69 cases >6 months from ASO). No subsequent interventional coronary artery procedures were reported in this cohort. There has only been one case that required coronary artery surgery subsequently.

Conclusion: Despite early neonatal surgical transfer of the coronary arteries, coronary artery morbidity or need for further coronary artery procedures during childhood and adolescence are extremely rare in patients after ASO. Although diagnostic coronary angiographies were recorded in approximately 22% of children after ASO, percutaneous intervention was not required in any case and only one individual (0.4%) underwent subsequent coronary artery surgery. Given the low apparent rate of coronary artery complications resulting in any (surgical) interventions, routine diagnostic coronary angiography does not appear to be justified during childhood or adolescence in this population. Further studies are warranted to assess coronary artery related morbidity in this evolving and aging population.

Publication History

Article published online:
28 January 2023