title: Coronary reimplantation after neoaortic reconstruction can yield better result in arterial switch operation: comparison with open trap door technique.
abstract: BACKGROUND
  Accurate coronary reimplantation is the most important component in the arterial switch operation. It is especially demanding for the less experienced surgeons. We compared the result of the technique of coronary reimplantation after neoaortic reconstruction with that of the open trap door technique.
  
  
  METHODS
  From March 1994 to June 2004, 103 consecutive patients underwent the arterial switch operation by one surgeon. Patients who underwent coronary artery transfer with other modified techniques were excluded. Diagnoses of 94 patients were transposition of the great arteries with intact ventricular septum (n = 50), transposition of the great arteries with ventricular septal defect (n = 26), and the Taussig-Bing anomaly (n = 18). An aortic arch anomaly was present in 13 patients. The median age of the patients was 12 days and the mean body weight was 3.5 kg. Coronary reimplantation after neoaortic reconstruction was applied to 34 patients (group I), and the open trap door technique was applied to the rest (group II).
  
  
  RESULTS
  Preoperative data were similar in both groups. Four patients in group II required intraoperative revision of a transferred coronary artery, and 1 patient with an intramural left coronary artery in group I had a conversion to free grafting using the left subclavian artery. Overall early mortality was 17.0% (16 of 94). Mortality in group I (1 of 34; 2.9%) was significantly lower than in group II (15 of 60; 25.0%) (p = 0.008). The leading cause of death in group II was low cardiac output (n = 9). During the follow-up, an aortic regurgitation of greater than mild was detected in 2 patients in group II.
  
  
  CONCLUSIONS
  Coronary reimplantation after neoaoartic reconstruction is an attractive method to minimize coronary artery transfer-related mortality or morbidity.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, South Korea.
authors.forename: Yun Hee
authors.initials: YH
authors.lastname: Chang
authors.forename: Si Chan
authors.initials: SC
authors.lastname: Sung
authors.forename: Hyoung Doo
authors.initials: HD
authors.lastname: Lee
authors.forename: Siho
authors.initials: S
authors.lastname: Kim
authors.forename: Jong Soo
authors.initials: JS
authors.lastname: Woo
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Lee
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D014188:Transposition of Great Vessels / Q000601:surgery*