Coronary Re-implantation after Completion of Neo-aortic Reconstruction in Arterial Switch Operation: Accurate Intraoperative Assessment for the Optimal Re-implantation Site

Abstract

The arterial switch operation (ASO) has evolved into the treatment of the choice for most forms of transposition of the great arteries (TGA). Despite advancement in the technical aspects of the procedure, certain anatomical variations of the coronary arteries are still considered as surgical risks. We have recently employed a novel technique for coronary artery reconstruction in ASO to achieve further improvement of coronary transfer in cases with complex coronary anatomy. The technical key of the procedure is that reconstruction of the coronary arteries is preceded by neo-aortic anastomosis. After neo-aortic reconstruction is accomplished, the neo-aorta is temporarily distended with removal of the cross-clamp. The distended neo-aorta informs us its postsurgical geometry, which facilitates accurate assessment for the optimal site of coronary button transfer.

Comparison of the Results of Open Trap-Door Technique and Closed Coronary Transfer Technique in Arterial Switch Operations: A Retrospective Clinical Study

“…7,10 Fakat bu teknik, neoaortaya transfer edilen koroner arterler için en uygun geometrik şekli sağlamada yeterli değildir. 25 Bove, optimal geometrik yapılandırmayı oluşturmak için kapalı koroner transfer tekniğini tanımlamıştır. 8 Bu tekniğe göre neoaortik rekonstrüksiyon yapıldıktan sonra, neoaortik kökte anastomoz için belirlenen en uygun yerlere koroner arterler transfer edilir.…”

Results of Application of the Modified “Closed” Method of Reimplantation of Coronary Arteries in Arterial Switch Operation

“…Suzuki и соавт. [25] изменили стратегию реимплан-тации с открытой на закрытую, отметив при этом улуч-шение непосредственных результатов и уменьшение ча-стоты возникновения осложнений со стороны КА.…”

Clinical guidelines for the management of patients with transposition of the great arteries with intact ventricular septum

“…The reconstruction is completed by the ascending aortic suture line to the superior end of the pouch [152]. None of these alternative methods was found to be superior; however, their use is recommended for single or 'too-close' ostia transfer [153][154][155][156][157][158][159].…”