Objective To summarize the clinical experiences of using the remaining coronary buttons to reconstruct the neoaortic root in the arterial switch operation (ASO) and discuss the clinical significance of preserving the morphology of aortic sinus in improving postoperative coronary artery perfusion. Methods From January 2003 to June 2009, 110 patients with transposition of great arteries (TGA) combined with ventricular septal defect (VSD ) or the Taussig Bing anomaly treated in our hospital were enrolled in this study. The patients were at the age between 2 days and 2 years averaged 91.1 days, and their body weight varied between 1.79 and 9.50 kg with an average weight of 4.70 kg. The patients were divided into two groups based on different surgical strategies. For group A (n=78), we reconstructed the neoaortic root with the remaining coronary buttons by shortening the diameter of the proximal neoaorta. While for group B (n=32), we excised the remaining coronary buttons with the aortopulmonary diameter mismatched. The risk factors of hospital mortality were analyzed with stepwise logistic regression. Results Twelve patients died early after operation with a death rate of 10.9% (12/110). Mortality in group A was significantly lower than that in group B ［6.4%(5/78) vs. 21.9%(7/32)，P= 0.019］. Clinical followup was completed in 72 survivors with the followup time of 3 months to 5 years after operation. Late death occurred in 3 patients including 1 in group A and 2 in group B. Five patients underwent reoperations. Univariate logistic regression analysis showed that risk factors for early postoperative death were TaussigBing anomaly (χ2=4.011,P=0.046), aortic arch anomaly (χ2=4.437,P=0.036), single coronary artery pattern (χ2=5.071,P=0.025) and patients in group B (χ2=5.584, P= 0.019). Multivariate analysis confirmed that the aortic arch anomaly (χ2= 5.681, P=0.010 ) and patients in group B (χ2=3.987, P=0.047 ) were two independent risk factors for early mortality after operation. Conclusion The modified technique which uses the remaining coronary buttons to reconstruct the neoaortic root can preserve the morphology of neoaortic root better. The special anatomical morphology of aortic sinus has close relation to the perfusion of coronary arteries. The lowering hospital mortality may be due to the better perfusion of the coronary arteries.
Abstract: Objective To investigate the clinical application of a novel modified aortic and pulmonic translocation in surgical repair of transposition of great arteries(TGA) with ventricular septal defect(VSD) and left ventricular outflow tract obstruction(LVOTO). Methods Five patients received surgical repair of the TGA with VSD and LVOTO at our heart center. The surgical technique used was a modification of the Nikaidoh procedure by which the native pulmonary root was preserved and translocated to reconstruct the right ventricular outflow tract. Two patients with atrioventricular discordance required a Senning procedure. Results All patients survived the operation and were discharged from the hospital. There were no major complications. At a median follow-up of 5.40 months, the echocardiography demonstrated normal ventricular function in all patients. No residual aortic stenosis or insufficiency was found in all the patients. Two patients had mild pulmonary insufficiency. Conclusions The novel modification of the Nikaidoh procedure may have excellent early results with minimal postoperative pulmonary insufficiency. The procedure may also allow growth of the pulmonary root and therefore decrease the need for reoperation. However, this has to be further investigated and long-term follow-up studies are warranted.