Results of a new technique of arterial switch operation for transposition of great arteries with single coronary artery

Background Transposition of great arteries (TGA) with Single Coronary artery is one of the high risk groups for Arterial Switch Operation (ASO). To eliminate this risk, we have innovated a new technique of ASO with insitu coronary re-allocation. We present our experience with this new technique. Methods From September 1998 to October 2005, ten consecutive cases of TGA with single coronary artery were operated employing this new technique. Their age ranged from 8 days to 9 months; their weight ranged from 2.6 to 5.8 Kgs. ASO was done by transecting the great arteries just above the commissures. For coronary re-allocation, hockey stick shaped incisions were made in the facing sinuses of the proximal aorta and the pulmonary artery. These flaps were sutured in such a way that the coronary ostium was committed to the neo-aorta. Results There was no in-hospital mortality. The follow-up ranged from 4 months to 7 years. All patients had follow-up echocardiogram at regular intervals, which showed no significant right or left ventricular outflow obstruction, no regional wall motion abnormalities and no, neo-aortic or neo-pulmonary regurgitation. Conclusion This new coronary re-allocation technique avoids problems related to coronary translocation such as traction and kinking. It spares the need for dissection of proximal coronary artery and its branches, and thereby eliminates the risk of development of fibrosis and stenosis. The same technique can be used regardless of the sinus of origin of the coronary artery. It is a reliable and reproducible technique. The early results were excellent.