title: Decreased incidence of supravalvar pulmonary stenosis after arterial switch operation.
abstract: BACKGROUND
  Supravalvar pulmonary stenosis (SVPS) is frequently observed after arterial switch. Traditionally the coronary arteries are removed from the neopulmonic root by excising the entire sinus of Valsalva. As a result, reconstruction of the neopulmonic root requires a pericardial patch encompassing two-thirds of the anastomosis between the neopulmonic root and pulmonary artery. We present a technique where the coronary arteries are removed as limited buttons of sinus tissue, leaving the transected edge of the neopulmonic root intact. We hypothesize that maintaining native arterial tissue in the anastomosis between the neopulmonic root and the pulmonary artery bifurcation reduces postoperative SVPS.
  
  
  RESULTS
  We performed a retrospective review of neonates with D-transposition of the great arteries undergoing arterial switch procedure from 1996 to 2009. Charts were reviewed, and clinical outcomes recorded for each patient. Most recent echocardiograms were evaluated for right ventricular outflow tract obstruction. A total of 120 patients received arterial switch using this technique. There was 99% survival and no injuries to the coronary arteries regardless of anatomy. Total follow-up was 564 patient-years. Mean follow-up at last clinical visit was 66 ± 46 months. Evaluation of the most recent outpatient echocardiogram revealed an average peak instantaneous gradient across the neopulmonic root of 22.5 ± 5 mm Hg. Only 7 (5%) patients required reintervention (balloon dilation, n=5; surgery, n=2).
  
  
  CONCLUSIONS
  Our technique of removing the coronary arteries as limited buttons, and anastomosis of the pulmonary artery using only native arterial tissue provides excellent midterm results with minimal SVPS.
authors.affiliation: University of Rochester, Strong Memorial Hospital, Rochester, NY 14642, USA. michael_swartz@urmc.rochester.edu
authors.forename: Michael F
authors.initials: MF
authors.lastname: Swartz
authors.forename: Ariel
authors.initials: A
authors.lastname: Sena
authors.forename: Nader
authors.initials: N
authors.lastname: Atallah-Yunes
authors.forename: Cecilia
authors.initials: C
authors.lastname: Meagher
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cholette
authors.forename: Francisco
authors.initials: F
authors.lastname: Gensini
authors.forename: George M
authors.initials: GM
authors.lastname: Alfieris
mesh_terms: D000015:Abnormalities, Multiple / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods; D000800:Angioplasty, Balloon; D001017:Aortic Coarctation / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D003330:Coronary Vessel Anomalies / Q000601:surgery; D003331:Coronary Vessels / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D011664:Pulmonary Valve / Q000601:surgery; D011666:Pulmonary Valve Stenosis / Q000453:epidemiology* / Q000209:etiology / Q000628:therapy; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000601:surgery; D014188:Transposition of Great Vessels / Q000473:pathology / Q000601:surgery*