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

Can J Cardiol. 2017 Sep;33(9):1180-1187. doi: 10.1016/j.cjca.2017.02.017. Epub 2017 Apr 8.


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.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Arterial Switch Operation / adverse effects*
  • Coronary Stenosis / complications*
  • Coronary Stenosis / mortality
  • Coronary Stenosis / surgery
  • Coronary Vessels / diagnostic imaging*
  • Death, Sudden, Cardiac / epidemiology
  • Death, Sudden, Cardiac / etiology*
  • Follow-Up Studies
  • Humans
  • Incidence
  • Postoperative Complications*
  • Risk Factors
  • Transposition of Great Vessels / surgery*