Coronary Anomalies and Early Surgical Outcomes in Transposition of the Great Arteries and Taussig-Bing Anomaly: Insights from 251 Consecutive Arterial Switch Cases.

Coronary artery anomalies (CAAs) are a critical factor in the arterial switch operation (ASO), yet their prognostic significance remains a matter of debate. This study aimed to evaluate the impact of CAAs on early outcomes, including mortality and postoperative recovery, in patients with transposition of the great arteries (TGA) and Taussig-Bing anomaly (TBA). We retrospectively analyzed 251 consecutive patients who underwent an ASO between 2010 and 2022. Coronary anatomy was classified intraoperatively according to the Leiden convention: Group I (usual, n = 181) and Group II (anomalous, n = 70). Preoperative, operative, and postoperative variables were compared. The primary outcome was early mortality (≤ 30 days or during hospitalization), and secondary outcomes included intensive care unit (ICU) and hospital stay, need for extracorporeal membrane oxygenation (ECMO), and major complications. Statistical analysis involved the Mann-Whitney U and Chi-squared tests; logistic regression was used to identify predictors of mortality. Coronary anomalies were identified in 70 patients (27.9%). Group II had higher median age (17.5 vs. 8 days, p = 0.003) and more associated anomalies (17.1% vs. 6.1%, p = 0.008), but mortality (11.4% vs. 8.3%, p = 0.43), ICU stay (11.5 vs. 11 days, p = 0.90), and hospital stay (21.5 vs. 20 days, p = 0.94) were comparable. In multivariable analysis, ECMO requirement (OR 31.0; 95% CI 10.0-95.9, p < 0.01) and prolonged ICU stay (OR 0.94; 95% CI 0.90-0.99, p = 0.04) were independent predictors of mortality, while CAAs were not. These findings suggest that coronary anatomy does not independently affect early outcomes after ASO, although complex variants may still increase technical difficulty and require individualized surgical strategies.