Arterial Switch Operation With and Without Coronary Relocation for Intramural Coronary Arteries

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• 作者：Hiroshi Koshiyama ; MD ; ^{hkoshi.md@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Mitsugi Nagashima ; MD ; Goki Matsumura ; MD ; Takeshi Hiramatsu ; MD ; Toshio Nakanishi ; MD ; Kenji Yamazaki ; MD
• 关键词：ASO ; arterial switch operation ; CABG ; coronary artery bypass grafting ; IMCA ; intramural coronary artery ; LAD ; left anterior descending ; LCA ; left coronary artery ; RCA ; right coronary artery ; TGA ; transposition of the great arteries ; VSD ; ventricular septal defect
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：102
• 期：4
• 页码：1353-1359
• 全文大小：1173 K

文摘

The arterial switch operation (ASO) for the transposition of the great arteries (TGA) with intramural coronary arteries has been performed using several techniques to avoid coronary events. We mainly performed ASO without coronary relocation by creating an aortopulmonary fenestration (Imai technique). Coronary circulation was rerouted by covering the aortopulmonary window and coronary orifices with a nonfacing sinus flap. Long-term results have not been reported. We describe our early and late results.

Methods

Among 551 patients who underwent an ASO between 1985 and 2014, intramural coronary arteries were detected in 15 of them. Coronary arteries were managed using 2 techniques: the double-button method in 5 patients (with unroofing and trapdoor incision in 1 patient) and the Imai technique in 10 patients.

Results

There were 3 hospital deaths and 3 deaths after discharge, 5 of which showed coronary complications. Actual survival and freedom from coronary complications at 15 years were 70% and 67%, respectively, with the Imai technique and 40% and 20%, respectively, with the double-button method. Late coronary intervention was performed for a long intramural coronary artery stenosis in 1 patient who underwent the Imai technique. In the others, late aortography showed good patency of the aortopulmonary window and growth of the coronary pouch after the Imai technique.

Conclusions

The Imai technique can be an option for coronary management in the presence of high-risk coronary anatomy, particularly distal intramural coronary artery stenosis and inseparable coronary arteries with an almost single orifice. Adequate neopulmonary artery augmentation must be performed to prevent right ventricular outflow stenosis.