title: In vitro evaluation of physiological spiral anastomoses for the arterial switch operation in simple transposition of the great arteries: a first step towards a surgical alternative?
abstract: OBJECTIVE
  The currently most frequently used technique for the arterial switch operation (ASO) in simple transposition of the great arteries (TGA) includes the transposition of the pulmonary artery anterior to the ascending aorta. This arterial arrangement is less anatomical, and although the initial results are excellent, some long-term data are indicating a certain risk of morbidity, encouraging the search for more physiological techniques. As a first step, we studied the feasibility of anatomical spiral anastomoses of the great vessels in vitro.
  
  
  METHODS
  A TGA model was constructed to simulate the different spatial positions of the great arteries followed by ASO with physiological spiral connections of the great arteries.
  
  
  RESULTS
  It was possible to perform a physiological spiral connection of the great arteries without tension or torsion when the roots of the great vessels were arranged anterior-posterior and with up to 35° rotation of the aortic root to the right around the pulmonary root. With further rotation of the aorta, patch plasties were required for pulmonary artery elongation. The maximal width of the patch was 5 mm.
  
  
  CONCLUSIONS
  In this TGA model, it was possible to perform tension- and torsion-free arterial anastomoses for ASO without artificial material, when the aortic root was positioned from 0° up to 35° to the right of the pulmonary root. Evaluation of coronary transfer is the next step.
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany hans-hinrich.sievers@uksh.de.
authors.forename: Hans-Hinrich
authors.initials: HH
authors.lastname: Sievers
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Scharfschwerdt
authors.affiliation: Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany.
authors.forename: Léon M
authors.initials: LM
authors.lastname: Putman
mesh_terms: D000714:Anastomosis, Surgical; D001011:Aorta / Q000601:surgery; D000069278:Arterial Switch Operation; D005240:Feasibility Studies; D006801:Humans; D007231:Infant, Newborn; D008953:Models, Anatomic; D011651:Pulmonary Artery / Q000601:surgery; D014188:Transposition of Great Vessels / Q000503:physiopathology* / Q000601:surgery*
keywords: Arterial switch operation; In vitro study; Simple transposition of the great arteries; Spiral anastomosis