Arterial Switch Operation in Patients With Single Sinus Coronary Artery Anatomy: Risk Factors for Mortality From a Lower-Middle Income Country.

Background: This study evaluates mortality and intermediate outcomes of the arterial switch operation (ASO) for transposition or Taussig-Bing anomaly with single sinus coronary artery (CA) anatomy in a high-volume cardiac program in Vietnam. Methods: We retrospectively reviewed and performed risk factor analysis pertaining to 41 consecutive patients who presented with single sinus CA anatomy and who underwent ASO from January 2010 to December 2016 in our center. Results: The median age at operation was 43 days [interquartile range (IQR): 20-65] and the median weight was 3.6 kg (IQR: 3.4-4.0). Four in-hospital deaths (9.8%), of which one was related to coronary insufficiency. There were no late deaths, with a median follow-up time of 7.2 years. Survival for all patients with single sinus CA was 90.2% at 1 year and remained constant at 5 years and 10 years after ASO. The presence of a coexisting aortic arch anomaly was the only risk factor for overall mortality identified in this study (hazard ratio: 8.66, P = .031, 95% confidence interval: 1.21-61.92). There were three cardiac reoperations. Freedom from reintervention after ASO for patients with single sinus CA at 1 year, 5 years, and 10 years were 97.3%, 91.9%, and 91.9%, respectively. Interestingly, among all patients undergoing ASO during this time period (n = 304), single-sinus CA anatomy was not a risk factor for overall death (P = .758). Conclusions: In a high-volume cardiac program in a lower middle-income country like Vietnam, ASO can be safely performed with single sinus CA anatomy, irrespective of the presenting coronary anatomy.

Complex transposition repair with aortic arch hypoplasia: a simple technique.

A modified technique of interdigitating aortic arch reconstruction was used successfully to treat 8 patients with complex congenital heart disease including transposition of the great arteries, ventricular septal defect, or Taussig-Bing anomalies combined with aortic arch hypoplasia and coarctation of the aorta, without the need for homograft tissue.