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Ann Thorac Surg 2005;80:1634-1640
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Coronary Reimplantation After Neoaortic Reconstruction Can Yield Better Result in Arterial Switch Operation: Comparison With Open Trap Door Technique

Yun Hee Chang, MD a , Si Chan Sung, MD a , * , Hyoung Doo Lee, MD b , Siho Kim, MD c , Jong Soo Woo, MD c , Young Seok Lee, MD d

a Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Seo-gu, Busan, South Korea
b Department of Pediatrics, Pusan National University Hospital, Seo-gu, Busan, South Korea
c Department of Thoracic and Cardiovascular Surgery, DongA University Hospital, Seo-gu, Busan, South Korea
d Department of Pediatrics, DongA University Hospital, Seo-gu, Busan, South Korea

Accepted for publication April 26, 2005.

* Address correspondence to Dr Sung, Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, 602-061 South Korea (Email: scsung21{at}hanmail.net).

Presented at the Poster Session of the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: Accurate coronary reimplantation is the most important component in the arterial switch operation. It is especially demanding for the less experienced surgeons. We compared the result of the technique of coronary reimplantation after neoaortic reconstruction with that of the open trap door technique.

METHODS: From March 1994 to June 2004, 103 consecutive patients underwent the arterial switch operation by one surgeon. Patients who underwent coronary artery transfer with other modified techniques were excluded. Diagnoses of 94 patients were transposition of the great arteries with intact ventricular septum (n = 50), transposition of the great arteries with ventricular septal defect (n = 26), and the Taussig-Bing anomaly (n = 18). An aortic arch anomaly was present in 13 patients. The median age of the patients was 12 days and the mean body weight was 3.5 kg. Coronary reimplantation after neoaortic reconstruction was applied to 34 patients (group I), and the open trap door technique was applied to the rest (group II).

RESULTS: Preoperative data were similar in both groups. Four patients in group II required intraoperative revision of a transferred coronary artery, and 1 patient with an intramural left coronary artery in group I had a conversion to free grafting using the left subclavian artery. Overall early mortality was 17.0% (16 of 94). Mortality in group I (1 of 34; 2.9%) was significantly lower than in group II (15 of 60; 25.0%) (p = 0.008). The leading cause of death in group II was low cardiac output (n = 9). During the follow-up, an aortic regurgitation of greater than mild was detected in 2 patients in group II.

CONCLUSIONS: Coronary reimplantation after neoaoartic reconstruction is an attractive method to minimize coronary artery transfer-related mortality or morbidity.




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