Techniques and Pitfalls of Coronary Arterial Reimplantation in
Anatomical Correction of Transposition
Abstract
Background and 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.