Related Experiment Video
Updated: Aug 15, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Coronary reimplantation after neoaortic reconstruction can yield better result in arterial switch operation:
Yun Hee Chang1, Si Chan Sung, Hyoung Doo Lee
1Department of Thoracic and Cardiovascular Surgery, Pusan National University Hospital, Busan, South Korea.
Insights
Coronary reimplantation after neoaortic reconstruction significantly reduces mortality in arterial switch operations compared to the open trap door technique. This method improves outcomes for complex congenital heart disease surgeries.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Background:
- Accurate coronary reimplantation is critical in arterial switch operations, posing challenges for less experienced surgeons.
- The study compares two coronary reimplantation techniques: after neoaortic reconstruction versus the open trap door method.
Purpose of the Study:
- To evaluate the efficacy and safety of coronary reimplantation after neoaortic reconstruction.
- To compare outcomes between two coronary reimplantation techniques in arterial switch operations.
Main Methods:
- A retrospective review of 103 patients undergoing arterial switch operations by a single surgeon.
- Patients were divided into two groups: Group I (coronary reimplantation after neoaortic reconstruction, n=34) and Group II (open trap door technique, n=60).
- Analysis included preoperative data, intraoperative complications, early mortality, and late aortic regurgitation.
Main Results:
- Early mortality was significantly lower in Group I (2.9%) compared to Group II (25.0%) (p=0.008).
- Intraoperative revision of coronary arteries was required in 4 patients in Group II.
- Late aortic regurgitation greater than mild was detected in 2 patients in Group II.
Conclusions:
- Coronary reimplantation after neoaortic reconstruction is an effective method to reduce mortality and morbidity associated with coronary artery transfer.
- This technique offers an attractive alternative for improving outcomes in complex pediatric cardiac surgery.
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.
