Oblique coronary transfer technique in arterial switch operation for
transposition of the great arteries
Abstract
Background: Mortality rates after the arterial switch operation (ASO)
for transposition of the great arteries (TGA) are still suboptimal
mainly due to postoperative myocardial ischemia. The present study aimed
to investigate the clinical impact of our modification of coronary
transplantation, wherein the coronary cuffs are transplanted oblique to
the pulmonary trunk to avoid torsion of the coronary arteries. Methods:
From September 2010 to August 2020, all 37 consecutive patients who
underwent ASO for TGA with our modification, i.e., the oblique coronary
transfer technique, were retrospectively reviewed. Cardiac dimensions
and patency of the coronary arteries were examined by cineangiography,
and hemodynamic parameters were measured by cardiac catheterization and
transthoracic echocardiography. Results: During a median 5.3 years of
postoperative follow-up, there were no deaths and no patient required
mechanical circulatory support. Median left ventricular ejection
fraction was 68.8% (interquartile range 66.8-71.0, minimum 54.6). All
patients maintained normal sinus rhythm without arrhythmia, except in
the early postoperative period. Five patients underwent unplanned
re-intervention for peripheral pulmonary stenosis, but none for coronary
insufficiency. The 8-year freedom from re-intervention rate was 85.6%.
Among a total of 110 transplanted coronary arteries, 108 (98.2%)
remained patent, and two circumflex arteries were occluded much later
after surgery, although with preserved ventricular function due to
compensatory growth of other coronary branches. Conclusion: The oblique
coronary transfer technique, which aims to avoid torsion of the coronary
arteries upon transplantation, provides good patency of the coronary
arteries and subsequent improvement of postoperative mortality rates
following ASO.