Comparison of the Results of Open Trap-Door Technique and Closed Coronary Transfer Technique in Arterial Switch Operations: A Retrospective Clinical Study

Abstract

Objective: Correct coronary translocation is the most important factor affecting the success of the operation in arterial switch operations. In this study, we compared the results of 2 different translocation techniques used for the transfer of coronary arteries. Material and Methods: Arterial switch surgery was performed on 108 consecutive patients between December 2017 and May 2022. The diagnoses of the patients were transposition of the great arteries with intact ventricular septum (n=68), transposition of the great arteries with ventricular septal defect (n=34) and Taussig-Bing anomaly (n=6). Aortic arch anomaly was accompanied in 7 patients. Coronary transfer was performed with the open trap-door technique in 70 of the patients (Group=1); closed coronary transfer method was applied in 38 patients (Group=2). Results: Eighty-six of the patients were male, 22 were female, median age was 13 days and mean body weight was 3.3 kg. There was no difference between the groups in terms of operative body weight, great artery relationship and presence of coronary anomaly. Early mortality was 12% (n=13) in all patients. Coronary artery anomaly was detected in 26 (24.1%) patients. Mortality was higher in patients with coronary artery anomaly than those without (p=0.006). There was no significant difference between Group 1 and Group 2 in terms of complications and mortality. In Group 2, cross-clamp time (p=0.009), cardiopulmonary bypass time (p=0.001), length of stay in the intensive care unit (p=0.01), length of hospital stay (p=0.001) and vasoactive inotrope score (p<0.001) was significantly lower than the patients in Group 1. At the follow-up, the rate of mild neo-aortic valve regurgitation in Group 1 was higher than in Group 2 (p=0.046). Conclusion: The closed technique provides shorter cross-clamp and cardiopulmonary bypass time, shorter intensive care unit and hospital stay, lower vasoactive inotrope score, and this technique reduces the risk of postoperative neoaortic valve insufficiency. Copyright © 2022 by Türkiye Klinikleri.