Abstract 15670: Intramural Coronary Artery is Predictive of Short and Long-Term Coronary Complications Following Arterial Switch Operation
Zachery Thompson, Ryan Bishop, Anna Thompson, Sara Stephens, Alyssa Kalustian, Jeffrey S HEINLE, Iki Adachi, Ziyad Binsalamah, Tam Doan- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Background: Intramural coronary arteries (IMCA) are associated with worse outcomes following arterial switch operations (ASO), though data on the effect of IMCA on longer term coronary complications following ASO remains sparse.
Hypothesis: IMCA increases the risk of coronary complications both short and long-term following ASO.
Methods: A retrospective cohort study included 393 patients with available data following ASO at a tertiary center (1995-2020). IMCA and Yacoub types were recorded from operative reports. Coronary outcomes included mortality (n=7), coronary reintervention (n=6), abnormal perfusion on stress imaging (n=4) or left ventricular (LV) dysfunction (n=7). Demographic and surgical data was collected. Wilcoxon rank-sum test assessed differences in continuous variables. We performed univariable Cox proportional hazard (PH) regression to examine time-to-event during 4 periods: the entire study period, 1-year, 5-year, and 10-year post-op. Multivariable Cox PH using Schoenfeld residuals with backward elimination was performed for the entire cohort and 1-year post-op.
Results: A total of 28/393 (7%) patients had IMCA. During a median follow-up of 10 years (4 - 17), 6% (n=24) had coronary complications. On univariable analyses, IMCA and Yacoub-B were associated with overall coronary complications. At 1-year, IMCA and Yacoub-C were predictive while higher operative weight and male sex were protective of outcomes. At 5- and 10-year post-op, IMCA remained predictive. On multivariate analysis, IMCA was an independent risk factor of coronary complications, hazard ratio of 11.09 (2.98-41.30), p<0.0001 at 1 year postop and 4.37 (1.73-11.04), p=0.002 for the entire study period.
Conclusions: Coronary related complications occurred in 6% of patients following ASO. Increased risk of immediate and long-term coronary complications after ASO in patients with IMCA supports a more intense follow-up and stress testing.