Outcomes of the modified Yacoub aortocoronary flap technique for ‘non-separable’ single sinus coronary arteries with intramural course in the neonatal arterial switch operation

Abstract

Objectives Coronary transfer remains the most crucial part of the arterial switch operation, yet certain coronary anatomies prohibit the use of button or trapdoor transfer techniques. In the rare setting of “non-separable” single sinus coronary arteries with intramural course, the modified Yacoub aortocoronary flap technique is a viable option. The aim of this study is to describe this operative technique and review its early and mid-term outcomes. Methods All cases with “non-separable” single sinus coronary arteries with intramural course where the modified Yacoub aortocoronary flap technique served as a bail-out option. Results Of 516 patients who underwent arterial switch operation at our institution between January 1977 and April 2022, 14 underwent the modified Yacoub aortocoronary flap technique. Median age at arterial switch operation was 10 (interquartile range 7-19) days. Hospital mortality occurred in 3 patients (21.4%), all being related to coronary complications. All hospital survivors were still alive at a median of 9.1 (interquartile range 4.2-18.3) years after the arterial switch operation. None of them developed complaints of ischemia, ventricular arrhythmias, ventricular dysfunction, or exercise intolerance. Surveillance computed tomography angiography showed stable aorto-coronary relationships free from stenosis, compression and kinking. No reoperations for coronary artery problems and/or neo-aortic valve or root problems were needed. Conclusions Although close monitoring of early coronary events seems crucial to prevent perioperative mortality, the modified Yacoub aortocoronary flap technique may serve as a viable bail-out option in patients with “non-separable” single sinus coronary anatomy with intramural course, with excellent results among hospital survivors.