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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2003 April;44(2):173-8

language: English

Implantation of the coronary arteries after reconstruction of the neoaorta by using pericardial or pulmonary hood techniques. A significant impact on the outcome of arterial switch operations

Tireli E., Korkut A. K., Basaran M.

Depart­ment of Car­di­o­vas­cular Sur­gery Istanbul Med­ical ­Faculty, ­Istanbul Uni­ver­sity, Istanbul, ­Turkey


Aim. Cor­o­nary ­artery ­anomaly and tech­niques ­used for ­their ­transfer are the ­major ­risk fac­tors for the arte­rial ­switch oper­a­tion. ­Although var­ious ­methods ­have ­been ­described, tor­sion and ­stretching of the cor­o­nary ­arteries con­tinue to ­trouble sur­geons. Espe­cially, in ­cases in ­which ­there is a ­size mis­match ­between the ­aorta and the pul­mo­nary ­artery, the ­true cor­o­nary implan­ta­tion ­points can ­change.
­Methods. We ­studied the inci­dence of myo­car­dial ­ischemia in 40 ­patients who under­went a ­Jatene pro­ce­dure ­from Jan­uary 1997 to ­August 2000 at ­Istanbul Med­ical ­Faculty of ­Istanbul Uni­ver­sity. In all ­cases; ­firstly, the neo-­aortic anas­tom­osis was per­formed. ­After ­filling the neo-­aorta by ­removing the ­aortic ­cross-­clamp, we ­aimed to iden­tify the ­exact cor­o­nary implan­ta­tion ­points. In 26 ­cases, ­direct re-implan­ta­tion or ­trap-­door tech­niques ­were the ­method of ­choice ­used for the implan­ta­tion. In 14 ­cases, we ­used per­i­car­dial or pul­mo­nary ­hood aug­men­ta­tion tech­niques. In 12 of ­these 14 ­cases, we ­used ­directly per­i­car­dial or pul­mo­nary ­hood for the main­te­nance of the ­exact cor­o­nary geom­etry ­because of the unfa­vor­able ­anatomy. In the ­remaining 2 ­patients, ­because of the deter­mi­na­tion of ­ischemic ­changes on the elec­tro­car­di­o­gram ­during the ­rewarming ­phase, we ­should ­revise the cor­o­nary anas­tom­osis by a per­i­car­dial ­hood.
­Results. One ­patient ­with intra­mural ­course of the cor­o­nary ­arteries ­died ­from of myo­car­dial ­ischemia. In the ­remaining 39 ­patients, we did not see post­op­er­a­tive mor­bidity and mor­tality ­because of the myo­car­dial ­ischemia.
Con­clu­sion. The use of per­i­car­dial or pul­mo­nary ­hood aug­men­ta­tion tech­niques is ­very ­helpful for the main­te­nance of the ­exact cor­o­nary geom­etry. Recon­struc­tion of the neo­aorta ­prior to cor­o­nary anas­tom­osis ­allows a ­more accu­rate deter­mi­na­tion of the ­true cor­o­nary implan­ta­tion ­points; espe­cially, if ­there is an ­abnormal rela­tion­ship and ­size mis­match ­between the ­great ves­sels. By ­this inno­va­tive tech­nique, the ­more accu­rate geom­etry and angu­la­tion of the cor­o­nary ­arteries can be ­achieved.

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