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September 10, 2012Circulation

Decreased Incidence of Supravalvar Pulmonary Stenosis After Arterial Switch Operation

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Key result

Arterial switch using limited coronary buttons yields ~5% RVOT reintervention rate.

  • n=120

Why the study?

Supravalvar pulmonary stenosis frequently occurs after arterial switch operation due to traditional coronary artery removal techniques requiring extensive pericardial patch reconstruction.

Does removing coronary arteries as limited buttons during arterial switch operation reduce postoperative supravalvar pulmonary stenosis and need for reintervention in neonates with D-transposition of the great arteries?

Population

120 neonates with D-transposition of the great arteries undergoing arterial switch procedure

Comparison

New technique removing coronary arteries as limited buttons vs traditional sinus excision

Design

Retrospective cohort study

Follow-up

Mean 66 ± 46 months

Authors

MSMichael F. SwartzUniversity of Rochester Medical CenterASAriel SenaRutgers, The State University of New JerseyNANader Atallah‐YunesUniversity of Rochester Medical Center

Discussion

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Overview

Supports limited-button coronary transfer in arterial switch; hypothesis-generating for reduced supravalvar stenosis, pending randomized confirmation in D-TGA.

Study Design

Type

Cohort (n=120)

Structured PICO

Does removing coronary arteries as limited buttons during arterial switch operation reduce postoperative supravalvar pulmonary stenosis and need for reintervention in neonates with D-transposition of the great arteries?

P
Population
120 neonates with D-transposition of the great arteries undergoing an arterial switch procedure, followed for a mean of 66 months.
E
Exposure
Arterial switch operation using a technique where coronary arteries are removed as limited buttons of sinus tissue, leaving the transected edge of the neopulmonic root intact, and anastomosis of the pulmonary artery using only native arterial tissue
O
Outcome
Right ventricular outflow tract obstruction (evaluated by peak instantaneous gradient across the neopulmonic root) and need for reinterventionhard clinical

Removing coronary arteries as limited buttons during the arterial switch operation provides excellent midterm results with a low rate of supravalvar pulmonary stenosis and need for reintervention.

Cite This Study

Swartz et al. (2012) conducted a cohort in D-transposition of the great arteries (n=120). Arterial switch procedure removing coronary arteries as limited buttons was evaluated on Reintervention for right ventricular outflow tract obstruction. An arterial switch technique removing coronary arteries as limited buttons yielded 99% survival and a 5% reintervention rate for right ventricular outflow tract obstruction over a mean of 66 months.

synapsesocial.com/papers/6aae3fec39b5b951acb695a5https://doi.org/10.1161/circulationaha.111.082867
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Also Consider

Synapse has enriched one closely related paper. Consider it for comparative context:

  1. 1Neo-aortic valvar function after the arterial switch2006 · 85 citations