Figure 1 - uploaded by Yusuke Yamamoto
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Cardiopulmonary bypass is commenced with arterial cannulation of the distal ascending aorta and bicaval venous cannulation. The ductus arteriosus is double ligated and divided with an additional purse string suture at the aortic stump. Ao, aorta; PA, pulmonary artery; PDA, patent ductus arteriosus; RA, right atrium; RV, right ventricle.
Source publication
The clinical results of the arterial switch operation (ASO) for dextro-transposition of the great arteries (d-TGA) are less than ideal when the anomaly is associated with an unusual coronary artery pattern, such as a single coronary artery or intramural coronary artery course. We developed a novel technique to deal with d-TGA with a single coronary...
Context in source publication
Context 1
... the pouch with the pulmonary trunk in a side-to-side fashion. This aortic sinus pouch technique not only facilitates the usual surgical maneuvers as compared with the usual coronary button transplantation, but it is also expected to prevent kinking and distortion of the transplanted coronary artery due to flexibility of the pouch itself (Figs. ...
Citations
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.
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.
