Abstract
Objective. Arterial switch operations (ASO) implicates that surgeon must change the true coronary artery (CA) anatomical position
that occasionally may induce acute coronary insufficiency because of CA distortion or compression. This life-threatening complication is usually fatal.
Material and methods. 14 ASO were performed in the Krasnoyarsk Center of Cardiovascular Surgery from 2012 to 2013 where
closed CA reimplantation technique were applied in 13 newborns and neonates. According to Leiden classification CA patterns were
as follows: 71,4% (1LCA, CxA; 2RCA); in 21.4% - "back loop" (1LCA; 2RCA, CxA). In one case, infant with Taussig-Bing anomaly
had a single CA arising from the non-facing sinus, which has significantly complicated translocation of the CA to the neo-aortic root.
Results. Transesophageal echocardiography in operating room showed slightly hypokinetic area of the interventricular septum in
6 (42.8%) patients, with complete restoring left ventricle (LV) systolic function within 1-3 days after surgery. Left ventricle ejection
fraction was not lower than 59,8 ± 9,9% in all cohort of patients. At the beginning, we did not close chest for any patient for
12-96 hours (mean 50,4 ± 28,8 hours ) regardless both body weight and duration of the operation. Mean cross-clamping time was
131,2 ± 24,1 min, bypass time 272 ± 26,7 min. The mean time on ventilator support did not exceed 366,8 ± 205,8 hrs and intensive
care unit (ICU) stay was 10,8 ± 4,5 days. During the follow-up, only one patient with human immunodeficiency virus (HIV) died on
34th postop day due to septic complications. Otherwise there was no mortality after ASO in our Hospital.
Conclusion. The technique of closed CA reimplantation makes surgeon be able to find the most fine position in the neo-aortic root
and allows to standardize approaches for ASO despite CA patterns.
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