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Canadian Journal of Cardiology

Sudden Death Due to Coronary Artery Lesions Long-term After the Arterial Switch Operation: A Systematic Review

Published:April 07, 2017DOI:https://doi.org/10.1016/j.cjca.2017.02.017

      Abstract

      Background

      The arterial switch operation (ASO) is the preferred procedure for children with dextrotransposition of the great arteries or Taussig-Bing anomaly. Short- as well as long-term outcome of ASO are excellent, but coronary artery stenoses are reported as a common long-term complication. It has been hypothesized that these might result in sudden cardiac death late after ASO.

      Methods

      A systematic search of PubMed and EMBASE was conducted to evaluate sudden cardiac death because of coronary complications late after ASO. Data on patients surviving ≥ 5 years post-ASO were collected from selected studies, corrected for duplicate data, and analyzed.

      Results

      After duplicate data correction 52 studies remained for data analysis. Among the 8798 survivors with follow-up, 27 patients died ≥ 5 years post-ASO (0.3%). Of these patients, 10 were known with relevant residual lesions. Five late deaths were sudden, possibly from a cardiac cause. None of the late sudden deaths were confirmed to be coronary-related.

      Conclusions

      Sudden cardiac death in asymptomatic patients as a result of coronary artery stenosis or occlusion is extremely rare, with 5 possible cases and no proven cases of coronary artery-related sudden cardiac death in 8798 patients with 66,450 patient follow-up years. Therefore, routine coronary imaging of asymptomatic, single-stage ASO patients is not justified.

      Résumé

      Introduction

      L’intervention de Jatene, aussi appelée switch artériel (ASO, de l’anglais arterial switch operation) est l’intervention privilégiée chez les enfants ayant une dextroposition des gros vaisseaux ou le syndrome de Taussig-Bing. Les résultats à court et à long terme de l’ASO sont excellents, mais les sténoses coronaires constitueraient une complication fréquente à long terme. On a émis l’hypothèse qu’elles entraînaient la mort cardiaque subite bien après l’ASO.

      Méthodes

      Nous avons mené une recherche systématique dans PubMed et EMBASE pour évaluer la mort cardiaque subite en raison des complications coronariennes qui surviennent tardivement après l’ASO. Issues des études retenues, les données sur les patients ayant survécu ≥ 5 ans après l’ASO ont été analysées après la correction des doublons.

      Résultats

      Après la correction des doublons, l’analyse de données a porté sur 52 études. Parmi les 8798 survivants ayant un suivi, 27 patients sont morts ≥ 5 ans après l’ASO (0,3 %). Parmi ces derniers, 10 patients étaient connus pour des lésions résiduelles pertinentes. Cinq morts subites sont survenues tardivement, possiblement d’une cause cardiaque. Aucune des morts subites survenues tardivement n’a été confirmée comme étant d’origine coronarienne.

      Conclusions

      La mort subite cardiaque chez les patients asymptomatiques à la suite d’une sténose ou d’une occlusion coronaires est extrêmement rare, soit 5 cas possibles et aucun cas prouvé de mort cardiaque subite d’origine coronarienne chez 8798 patients, soit 66 450 rencontres de suivi au cours des années. Par conséquent, l’imagerie coronarienne systématique des patients asymptomatiques subissant une ASO en une seule étape n’est pas justifiée.
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