Modified Closed Coronary Transfer is a Good Alternative to the Trap-Door Method During Arterial Switch Operation: a Retrospective Propensity-Matched Comparison.

Mehmet Dedemoğlu,Mehmet Biçer,Oktay Korun,Fatih Özdemir,Okan Yurdakök,Murat Çiçek,Gültekin Coşkun,Numan Ali Aydemir,Filiz İzgi Coşkun,Ahmet Şaşmazel

doi:10.21470/1678-9741-2019-0263

Abstract

Objective To compare the early and long-term results of patients in whom was performed modified closed coronary transfer with the results of patients in whom was performed trap-door transfer techniques by utilizing propensity-matching analysis to provide optimal identical patient matching for the groups.Methods From August 2015 to December 2017, 127 consecutive patients underwent arterial switch operation due to simple and complex transposition of the great arteries, with or without additional arch and complex coronary pattern, by a single surgical team included into the study. Of these, in 70 patients it was performed modified closed coronary transfer technique and in 57 patients it was performed trap-door style coronary transfer technique. The patients were divided into two groups in terms of coronary transfer method. In the final model, after propensity matching, 47 patients from each group having similar propensity score were included into the study.Results There was no significant difference between the groups regarding patient characteristics. Cross-clamp time and operation time were significantly lower in the modified technique group compared with the other group (P=0.03 and P=0.05, respectively). When compared the early and late postoperative outcomes, there was no significant difference between the groups. Postoperative echocardiographic findings were mostly similar between the groups.Conclusion The patients in whom was performed our modified technique demonstrate overall good outcomes and the current technique ensures shorter arterial cross-clamp and operation times. It may be an alternative method to the trap-door technique for the coronary transfer during the arterial switch operation.

Highlights

Arterial switch operation (ASO) has become a standard surgical procedure for the treatment of transposition of the great arteries (TGA) and some forms of double outlet right ventricle (DORV) with low mortality and excellent long-term results[1,2], since it was first described by Jatene et al.[3]
When compared the early and late postoperative outcomes, there was no significant difference between the groups
It may be an alternative method to the trap-door technique for the coronary transfer during the arterial switch operation

Summary

Introduction

Arterial switch operation (ASO) has become a standard surgical procedure for the treatment of transposition of the great arteries (TGA) and some forms of double outlet right ventricle (DORV) with low mortality and excellent long-term results[1,2], since it was first described by Jatene et al.[3]. Mortality after ASO is almost always related to coronary artery failure[4]. Technical modifications for optimal coronary configuration during coronary reimplantation have minimized the risk related to coronary artery failure[10]. In this context, different coronary transfer techniques have been described for coronary reimplantation[11]. The most commonly used method is the trap-door coronary transfer technique, which minimized the rotation angle of the coronary artery[12]. The closed coronary transfer technique, which provides optimal geometric configuration for the coronary arteries, is a method accepted in the literature[13]

Methods

Results

Discussion

Conclusion