2024 年 8 巻 1 号 p. 8-14
Coronary artery stenosis or occlusion following coronary transfer procedures in congenital heart surgery is a rare but serious complication that often leads to severe heart failure. This complication often needs extracorporeal membrane oxygenation support in the early stage and is associated with sudden death or the need for heart transplantation later after surgery. The complication is particularly important in an arterial switch operation for transposition of the great arteries (TGA), which is performed in newborns and infants with low body weight. Additionally, TGA is often associated with various anatomical coronary abnormalities. Two surgical procedures have been used to manage this complication: surgical redo of coronary ostial anastomosis, often with autologous tissue patch enlargement (SOAP) and pediatric coronary artery bypass surgery using the internal thoracic artery (PCABS-ITA). Both methods have relative advantages and disadvantages but early surgical survival results are equivalent. Based on various database analyses, I currently consider SOAP as I(C) and PCABS-ITA as IIa(C) for a rescue operation in which coronary obstruction is due to technical errors or mechanical compression, kinking, and/or stretching. For late coronary complications in which fibroproliferative obstruction is the main cause, I recommend PCABS-ITA as I(C) and SOAP as IIa(C). In addition, tight stenosis (>90%) or total obstruction extending into the bifurcation of the left main trunk favors PCABS-ITA, whereas localized left main stenosis of a less severe degree favors SOAP. Careful follow-up and long-term results are important. Because coronary obstruction is a serious but rare complication, analysis of long-term data is essential.
