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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Article info
Publication history
Published online: April 07, 2017
Accepted:
February 27,
2017
Received:
July 25,
2016
Footnotes
See page 1186 for disclosure information.
Identification
Copyright
© 2017 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
