Application of Double Flap Extension Technique in Complicated Arterial Switch Operation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Shunmin , XU Zhiwei , LIU Jinfen

Department of Thoracic and Cardiovascular Surgery， Shanghai Children’s Medical Center， Medical College of Shanghai Jiaotong University， Shanghai 200127， P. R China;

Corresponding author：

Keywords：

D-transposition of the great arteries; ?Arterial switch operation; ?Double flap extension; ?Taussig-Bing anomaly

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Abstract：　Objective?To summarize the clinical experience，surgical technique and indication of coronary artery implantation with double flap extension technique in arterial switch operations （ASO） in D-transposition of the great arteries （D-TGA） and Taussig-Bing anomalies.?Methods?From January 2006 to June 2011， 21 patients （13 males and 8 females；age 110.0±84.5 d；weight 5.4±4.2 kg） with D-TGA or Taussig-Bing anomalies associated with complex coronary artery malformations underwent ASO with double flap extension technique for coronary artery implantation in Shanghai Children’s Medical Center affiliated to Medical College of Shanghai Jiaotong University. All the patients had a main trunk of right coronary artery or dilated right ventricular conus branch originated from the left or right aortic sinus，with abnormal course of anterior looping to the aorta. The double flap extension technique was described as followed： a long coronary button was excised as a flap from the aorta; another pedicle flap on the pulmonary artery （neoaorta） was cut to extend to the button of coronary artery with an equal distance; the side edges of the flap and the button were sutured together to form a lengthened coronary artery tube.?Results?No operative death occurred in hospital. The postoperative duration of mechanical ventilation was 101.6±53.6 h. The duration of ICU stay was 9.5±4.9 d. Postoperatively，low cardiac output syndrome occurred in 9 cases，pulmonary hypertension crisis in 2 cases，pneumonia in 6 cases，and acute kidney failure in 2 cases. Eleven patients underwent delayed sternum closure. All the patients were discharged after proper treatment. Follow-up was complete in 17 cases. The duration of follow-up was 2 months to 5 years. Growth and development were significantly improved in all the patients during follow-up. No patient had ischemic ECG changes. One patient underwent reoperation for supravalvular pulmonary stenosis 2 years after ASO.?Conclusion?Double flap extension technique for coronary implantation in complicated ASO can significantly decrease postoperative death due to coronary artery malformations，especially for patients who have two-stage ASO and patients whose main trunk of right coronary artery or dilated right ventricular conus branch originates from the left or right aortic sinus with abnormal course of anterior looping to the aorta.

Citation： WANG Shunmin,XU Zhiwei,LIU Jinfen,et al. Application of Double Flap Extension Technique in Complicated Arterial Switch Operation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(4): 345-349. doi: Copy

1.	王顺民，徐志伟，刘锦纷，等. 室间隔完整型完全性大动脉错位手术治疗分析. 上海交通大学学报（医学版）， 2011， 31 （9）：1245-1249.
2.	Freed DH， Robertson CM， Sauve RS， et al. Intermediate-term outcomes of the arterial Switch operation for transposition of great arteries in　neonates： alive but well? J Thorac Cardiovasc Surg， 2006， 132 （4）： 845-852.
3.	Sarris GE， Chatzis AC， Giannopoulos NM， et al. The arterial Switch operation in Europe for transposition of the great arteries： a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg， 2006， 132 （3）： 633-639.
4.	Alsoufi B， Cai S， Williams WG， et al. Improved results with single-stage total correction of Taussig-Bing anomaly. Eur J Cardiothorac Surg， 2008， 33 （2）： 244-250.
5.	Gittenberger-de Groot AC， Sauer U， Quaegebeur J. Aortic intramural coronary artery in three hearts with transposition of the great arteries. J Thorac Cardiovasc Surg， 1986， 91 （4）：566-571.
6.	Qamar ZA， Goldberg CS， Devaney EJ， et al. Current risk factors and outcomes for the arterial Switch operation. Ann Thorac Surg， 2007， 84 （3）： 871-878.
7.	Gottlieb D， Schwartz ML， Bischoff K， et al. Predictors of outcome of arterial Switch operation for complex D-transposition. Ann Thorac Surg， 2008， 85 （5）： 1698-1702.
8.	Ugurlucan M， Sayin OA，Surmen B， et al. Coronary reimplantation after neoaortic reconstruction in arterial switch operation. Ann Thorac Surg， 2006， 82 （1）：382.
9.	Raisky O， Bergoend E， Agnoletti G， et al. Late coronary artery lesions after neonatal arterial Switch operation： results of surgical coronary revascularization. Eur J Cardiothorac Surg， 2007， 31 （5）： 894-898.
10.	Yamagishi M，Shuntoh K， Fujiwara K， et al.“Bay window” technique for the arterial switch operation of the transposition of the great arteries with complex coronary arteries. Ann Thorac Surg， 2003， 75 （6）：1769-1774.
11.	Shukla V， Freedom RM， Black MD. Single coronary artery and complete transposition of the great arteries： a technical challenge resolved? Ann Thorac Surg，2000， 69 （2）： 568-571.
12.	Murthy KS， Coelho R， Kulkarni S， et al. Arterial Switch operation with in situ coronary reallocation for transposition of great arteries with single coronary artery. Eur J Cardiothorac Surg， 2004，25 （2）： 246-249.
13.	王顺民，徐志伟，刘锦纷，等. 利用“多余”冠状动脉纽片作主动脉根部成形在大动脉转位术中的应用. 中国胸心血管外科临床杂志， 2010， 17 （3）：182-187.
14.	Planché C， Bruniaux J， Lacour-Gayet F， et al. Switch operation for transposition of the great arteries in neonates. A study of 120 patients. J Thorac Cardiovasc Surg， 1988， 96 （3）： 354-363.
15.	Lacour-Gayet F. Arterial Switch operation with ventricular septal defect repair and aortic arch Reconstruction. Semin Thorac Cardiovasc Surg， 2007， 19 （3）： 245-248.
16.	Lacour-Gayet F， Anderson RH. A uniform surgical technique for transfer of both simple and complex patterns of the coronary arteries during the arterial Switch procedure. Cardiol Young， 2005， 15 Suppl 1 （Suppl 1）： 93-101.
17.	Scheule AM， Zurakowski D， Blume ED， et al. Arterial Switch operation with a single coronary artery. J Thorac Cardiovasc Surg， 2002， 123 （6）： 1164-1172.
18.	Sese A， Imoto Y. New technique in the transfer of an anomalously originated left coronary artery to the aorta. Ann Thorac Surg， 1992， 53 （3）： 527-529.
19.	Alexi-Meskishvili V， Nasseri BA， Nordmeyer S， et al. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children. J Thorac Cardiovasc Surg， 2011， 142 （4）： 868-874.
20.	Takeuchi S， Katogi T. New technique for the arterial switch operation in difficult situations. Ann Thorac Surg， 1990， 50 （6）：1000- 1001.

1. 　王顺民，徐志伟，刘锦纷，等. 室间隔完整型完全性大动脉错位手术治疗分析. 上海交通大学学报（医学版）， 2011， 31 （9）：1245-1249.
2. 　 Freed DH， Robertson CM， Sauve RS， et al. Intermediate-term outcomes of the arterial Switch operation for transposition of great arteries in　neonates： alive but well? J Thorac Cardiovasc Surg， 2006， 132 （4）： 845-852.
3. 　Sarris GE， Chatzis AC， Giannopoulos NM， et al. The arterial Switch operation in Europe for transposition of the great arteries： a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg， 2006， 132 （3）： 633-639.
4. 　Alsoufi B， Cai S， Williams WG， et al. Improved results with single-stage total correction of Taussig-Bing anomaly. Eur J Cardiothorac Surg， 2008， 33 （2）： 244-250.
5. 　Gittenberger-de Groot AC， Sauer U， Quaegebeur J. Aortic intramural coronary artery in three hearts with transposition of the great arteries. J Thorac Cardiovasc Surg， 1986， 91 （4）：566-571.
6. 　Qamar ZA， Goldberg CS， Devaney EJ， et al. Current risk factors and outcomes for the arterial Switch operation. Ann Thorac Surg， 2007， 84 （3）： 871-878.
7. 　Gottlieb D， Schwartz ML， Bischoff K， et al. Predictors of outcome of arterial Switch operation for complex D-transposition. Ann Thorac Surg， 2008， 85 （5）： 1698-1702.
8. 　Ugurlucan M， Sayin OA，Surmen B， et al. Coronary reimplantation after neoaortic reconstruction in arterial switch operation. Ann Thorac Surg， 2006， 82 （1）：382.
9. 　Raisky O， Bergoend E， Agnoletti G， et al. Late coronary artery lesions after neonatal arterial Switch operation： results of surgical coronary revascularization. Eur J Cardiothorac Surg， 2007， 31 （5）： 894-898.
10. 　Yamagishi M，Shuntoh K， Fujiwara K， et al.“Bay window” technique for the arterial switch operation of the transposition of the great arteries with complex coronary arteries. Ann Thorac Surg， 2003， 75 （6）：1769-1774.
11. 　Shukla V， Freedom RM， Black MD. Single coronary artery and complete transposition of the great arteries： a technical challenge resolved? Ann Thorac Surg，2000， 69 （2）： 568-571.
12. 　 Murthy KS， Coelho R， Kulkarni S， et al. Arterial Switch operation with in situ coronary reallocation for transposition of great arteries with single coronary artery. Eur J Cardiothorac Surg， 2004，25 （2）： 246-249.
13. 　王顺民，徐志伟，刘锦纷，等. 利用“多余”冠状动脉纽片作主动脉根部成形在大动脉转位术中的应用. 中国胸心血管外科临床杂志， 2010， 17 （3）：182-187.
14. 　Planché C， Bruniaux J， Lacour-Gayet F， et al. Switch operation for transposition of the great arteries in neonates. A study of 120 patients. J Thorac Cardiovasc Surg， 1988， 96 （3）： 354-363.
15. 　Lacour-Gayet F. Arterial Switch operation with ventricular septal defect repair and aortic arch Reconstruction. Semin Thorac Cardiovasc Surg， 2007， 19 （3）： 245-248.
16. 　 Lacour-Gayet F， Anderson RH. A uniform surgical technique for transfer of both simple and complex patterns of the coronary arteries during the arterial Switch procedure. Cardiol Young， 2005， 15 Suppl 1 （Suppl 1）： 93-101.
17. 　Scheule AM， Zurakowski D， Blume ED， et al. Arterial Switch operation with a single coronary artery. J Thorac Cardiovasc Surg， 2002， 123 （6）： 1164-1172.
18. 　Sese A， Imoto Y. New technique in the transfer of an anomalously originated left coronary artery to the aorta. Ann Thorac Surg， 1992， 53 （3）： 527-529.
19. 　Alexi-Meskishvili V， Nasseri BA， Nordmeyer S， et al. Repair of anomalous origin of the left coronary artery from the pulmonary artery in infants and children. J Thorac Cardiovasc Surg， 2011， 142 （4）： 868-874.
20. 　Takeuchi S， Katogi T. New technique for the arterial switch operation in difficult situations. Ann Thorac Surg， 1990， 50 （6）：1000- 1001.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of Double Flap Extension Technique in Complicated Arterial Switch Operation

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