Sudden death due to coronary artery lesions long term after the arterial switch operation: A Systematic Review

Abstract Background The arterial switch operation (ASO) is the preferred procedure for children with dextro-transposition of the great arteries (d-TGA) or Taussig-Bing anomaly (TBA). Both short and 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 may result in sudden cardiac death late after ASO. Methods A systematic search of PubMed and EMBASE was conducted to evaluate sudden cardiac death due to 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 8,798 survivors with follow-up, 27 patients died ≥5 years post-ASO (0.3%). Of these patiens, ten 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 five possible cases and no proven cases of coronary artery-related SCD in 8,798 patients with 66,450 patient follow-up years. Therefore, routine coronary imaging of asymptomatic, single-stage ASO patients is not justified.