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

Authors :
Jong Soo Woo
Yun Hee Chang
Hyoung Doo Lee
Si Chan Sung
Young Seok Lee
Siho Kim
Source :
The Annals of Thoracic Surgery. 80:1634-1640
Publication Year :
2005
Publisher :
Elsevier BV, 2005.

Abstract

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.

Details

ISSN :
00034975
Volume :
80
Database :
OpenAIRE
Journal :
The Annals of Thoracic Surgery
Accession number :
edsair.doi.dedup.....5a8cf3caf0a685cd109112e6ba442a39
Full Text :
https://doi.org/10.1016/j.athoracsur.2005.04.056