Abstract 15017: Decreased Incidence of Supravalvar Pulmonary Stenosis Following Modified Technique of Arterial Switch Operation
Objective: Supravalvar pulmonary stenosis (SVPS) is frequently observed after arterial switch. Traditionally, the ascending aorta is transected at the level of the sinotubular junction and the coronary arteries are excised with the entire associated Sinus of Valsalva. As a result, reconstruction of the neo-pulmonic root requires a pericardial patch encompassing 2/3 of the anastomosis between the neo-pulmonic root and pulmonary artery. We hypothesized that reconstruction of the neo-pulmonic root and pulmonary artery bifurcation under minimal tension and using only native arterial tissue in the anastomosis reduces the incidence of SVPS.
Methods: The aorta is divided midway between the innominate artery and sinotubular junction. As a result, the distal ascending aorta is shortened and displaced inferior-posteriorly after the anastomosis with the neoaortic root. This allows the pulmonary artery bifurcation to be under minimal tension after the LeCompte maneuver. The coronary arteries are removed from the neo-pulmonic root as limited buttons of sinus tissue, leaving the transected edge intact and an anastomosis between the neo-pulmonic root and pulmonary artery bifurcation of only arterial tissue.
Results: From 1996-2009 120 consecutive patients received the arterial switch operation using this technique. There was one post-operative death (0.8%). There were no injuries to the coronary arteries. Follow-up was available for 109(90%) patients at a mean duration of 5.1 ± 4.0 years. Total follow-up was 564.2 patient years. From the most recent echocardiogram, the peak instantaneous gradient across the neo-pulmonic root was a mean of 22.5 ±5 mm Hg. Two (1.8%) patients required reoperation at1 and 1.5 years, after placement of the neo-pulmonic root to the branch pulmonary arteries for complex anatomy and 5(4.1%) patients required balloon dilation between three and eleven years. The freedom from re-operation and re-intervention was 97.1% and 86.3% at 14.75 years.
Conclusion: Our technique of reconstructing the neo-pulmonic root under minimal tension, removing the coronary arteries as limited buttons, and creating an anastomosis of only native arterial tissue provides excellent mid-term results with minimal SVPS.
- © 2011 by American Heart Association, Inc.