Techniques and Pitfalls of Coronary Arterial Reimplantation in Anatomical Correction of Transposition

Abstract

Backgroundand Aim: We assessed the anatomical variations in coronary arterial patterns relative to the techniques of reimplantation in the setting of the arterial switch operation, relating the variations to influences on outcomes. Methods: We reviewed pertinent published investigations, assessing events reported following varied surgical techniques for reimplantation of the coronary arteries in the setting of the arterial switch procedure. Results: The prevalence of reported adverse events, subsequent to reimplantation, varied from 2% to 11%, with a bimodal presentation of high early and low late incidence. The intramural pattern continues to contribute to mortality, with some reports of 28% fatality. The presence of abnormal course relative to the arterial pedicles in the setting of single sinus origin was associated with a three-fold increase in mortality. Abnormal looping with bisinusal origin of arteries was not associated with increased risk. Conclusion: The techniques of transfer of the coronary arteries can be individually adapted to cater for the anatomical variations. Cardiac surgeons, therefore, need to be familiar with the myriad creative options available to achieve successful repair when there is challenging anatomy. Long-term follow-up will be required to affirm the superiority of any specific individual technique. Detailed multiplanar computed-tomographic scanning can now reveal all the variants, and elucidate the mechanisms of late complications. Coronary angioplasty or surgical revascularization may be considered in selected cases subsequent to the switch procedure.

Is coronary artery transfer still the jugular for the arterial switch operation?

“…The shift in momentum towards the arterial switch was due to increased experience with safe coronary transfer techniques and an early application of the operation before regression of the morphological left ventricle, leading to improved outcomes [2]. While some single institution series have reported no operative mortality directly attributable to coronary artery variation and transfer technique [3], Chowdhury and colleagues, in their expert review, have synthesized a cumulative impact of coronary artery variation on the short and long-term outcomes of the arterial switch operation from previously published studies [4].…”

Is coronary artery transfer still the jugular for the arterial switch operation?

“…The shift in momentum towards the arterial switch was due to increased experience with safe coronary transfer techniques and an early application of the operation before regression of the morphological left ventricle, leading to improved outcomes 2 . While some single institution series have reported no operative mortality directly attributable to coronary artery variation and transfer technique, 3 Chowdhury et al, 4 in their expert review, have synthesized a cumulative impact of coronary artery variation on the short and long‐term outcomes of the arterial switch operation from previously published studies.…”