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Ann Thorac Surg 2006;82:382
© 2006 The Society of Thoracic Surgeons

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Correspondence

Coronary Reimplantaton After Neoaortic Reconstruction in Arterial Switch Operation

Department of Cardiovascular Surgery, stanbul University, Istanbul Medical Faculty, Millet Caddesi, Capa, Fatih, Istanbul, 34390 Turkey

(Email: emintireli{at}yahoo.com).

To the Editor:

We read with interest the article by Chang and colleagues [1]. There are different coronary artery transfer techniques defined for the arterial switch operations (ASO).

In our ASO series of 85 patients, the coronary reimplantations were completed after completion of the neoaortic anastomosis in all the cases we performed [2]. This is an easier and practical technique as stated by Chang and colleagues [1]. However, we have issues with the article by Chang and colleagues [1]. Although they state that this technique is easier and practical, the cross-clamp time is longer when compared with the open trap door technique. The mean cross-clamp times for our first 40 cases and for the patients operated on after the year 2003 were 80 and 54 minutes, respectively.

According to our experience, when the right coronary artery (RCA) and circumflex coronary artery (Cx) or left anterior descending coronary artery (LAD), RCA, and Cx originate from sinus II (posterior looping), completion of the neoaortic anastomosis before implantation of these buttons has some disadvantages because the implantation site of these buttons would lie at or above the neoaortic anastomosis. Because of this we prefer to construct most of the neoaortic anastomosis but not complete a 3 to 4 mm region for attaching the button of sinus II. We then clamp this open area with two fine forceps, remove the aortic cross clamp, fill the neoaorta, and connect the buttons of sinus II either at or above the neoaortic anastomosis. Among our 12 patients in whom the RCA and Cx originated from sinus II, coronary buttons were placed just on to the neoaortic anastomosis in 8 patients and above the anastomosis in 4. The coronary buttons were placed on the neoaortic anastomosis in our 5 patients in whom all three coronary arteries originated from sinus II. In the 34 patients reported by Chang and colleagues [1], the RCA and Cx originated from sinus II in 5 patients and the LAD, RCA, and Cx originated from sinus II in 1. They performed the sinus II button anastomosis after completion of the neoaortic anastomosis. However, the best position for these buttons may have been on or above the neoaortic anastomosis. Therefore they should explain how they managed placement of the coronary buttons if the best position was on the neoaortic anastomosis. How did they prevent coronary ischemia?

Finally, coronary reimplantation after the neoaortic reconstruction facilitates arterial switch operation (ASO). Completion of neoaortic anastomosis before coronary reimplantation does not cause major complications in most ASO cases; however, we believe that in patients with posterior looping configurations, completion of the neoaortic anastomosis prior to coronary button reimplantation is not suitable. In these cases we suggest leaving a 3 to 4 mm open region at the neoaortic anastomosis for possible placement of the coronary button.

	References

Top References

 

1. Chang YH, Sung SC, Lee DH, et al. Coronary reimplantation after neoaortic reconstruction can yield better result in arterial switch operationcomparison with open trap door technique. Ann Thorac Surg 2005;80:1634-1640.[Abstract/Free Full Text]
2. Tireli E, Korkut AK, Basaran M. 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 J Cardiovasc Surg 2003;44:173-178.[Medline]

This article has been cited by other articles:

				M. Ugurlucan, B. Surmen, O. A. Sayin, E. Nargileci, and E. Tireli Coronary Reimplantation During Jatene Procedure Ann. Thorac. Surg., January 1, 2007; 83(1): 356 - 357. [Full Text] [PDF]

				Y. H. Chang and S. C. Sung Reply. Ann. Thorac. Surg., July 1, 2006; 82(1): 383 - 383. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Emin Tireli Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ugurlucan, M. Articles by Tireli, E. Search for Related Content PubMed PubMed Citation Articles by Ugurlucan, M. Articles by Tireli, E. Related Collections Congenital - cyanotic Related Article