A new technique of arterial switch operation with in situ coronary reallocation for transposition of great arteries.

Coronary artery translocation is the most important step in achieving a successful result in arterial switch operations. Although a few centers have reported excellent results, coronary artery transfer requires a high technical expertise. We report a new technique of arterial switch operation without coronary translocation. By creating flaps in the proximal great arteries, the coronaries are transferred to the neoaorta without distortion of their original anatomic position. This technique avoids problems related to coronary translocation. Because coronary buttons are not excised, there is no need for nonviable material to be used in reconstruction of neopulmonary artery. Arterial wall is sutured to arterial wall, so postoperative bleeding is lessened. This technique can be used for any type of coronary anomaly and great arterial relationship. Coronary perfusion is well maintained. Two patients with transposition variants and ventricular septal defects have been operated on successfully with this technique. Postoperative investigations showed good coronary perfusion, without right or left ventricular outflow obstruction or leakage through the semilunar valves. This technique achieves anatomic correction for transposition of the great arteries, just as a conventional arterial switch operation does, but it avoids problems related to coronary artery translocation. We believe that it is a much simpler, more reliable, and more reproducible operation than others in current use, and it can be carried out by many cardiac surgeons with acceptable results. The early results are encouraging, although longer follow-up and more cases are essential.