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Techniques and Pitfalls of Coronary Arterial Reimplantation in Anatomical Correction of Transposition
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  • Ujjwal Chowdhury,
  • Robert Anderson,
  • Diane E. Spicer,
  • Lakshmi Sankhyan,
  • Niwin George,
  • Niraj Pandey,
  • Shikha Goja,
  • Balaji Chandhirasekar
Ujjwal Chowdhury
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre

Corresponding Author:ujjwalchowdhury@gmail.com

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Robert Anderson
Newcastle University
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Diane E. Spicer
Johns Hopkins All Children's Hospital Heart Institute
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Lakshmi Sankhyan
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Niwin George
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Niraj Pandey
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Shikha Goja
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Balaji Chandhirasekar
All India Institute of Medical Sciences Cardio-Thoracic Sciences Centre
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Abstract

Background and Aim: We assessed the anatomical variations in coronary arterial patterns relative to the techniques of reimplantation in the setting of the arterial switch operation, relating the variations to influences on outcomes. Methods: We reviewed pertinent published investigations, assessing events reported following varied surgical techniques for reimplantation of the coronary arteries in the setting of the arterial switch procedure. Results: The prevalence of reported adverse events, subsequent to reimplantation, varied from 2% to 11%, with a bimodal presentation of high early and low late incidence. The intramural pattern continues to contribute to mortality, with some reports of 28% fatality. The presence of abnormal course relative to the arterial pedicles in the setting of single sinus origin was associated with a three-fold increase in mortality. Abnormal looping with bisinusal origin of arteries was not associated with increased risk. Conclusion: The techniques of transfer of the coronary arteries can be individually adapted to cater for the anatomical variations. Cardiac surgeons, therefore, need to be familiar with the myriad creative options available to achieve successful repair when there is challenging anatomy. Long-term follow-up will be required to affirm the superiority of any specific individual technique. Detailed multiplanar computed-tomographic scanning can now reveal all the variants, and elucidate the mechanisms of late complications. Coronary angioplasty or surgical revascularization may be considered in selected cases subsequent to the switch procedure.
07 Jun 2022Submitted to Journal of Cardiac Surgery
07 Jun 2022Submission Checks Completed
07 Jun 2022Assigned to Editor
09 Jun 2022Reviewer(s) Assigned
30 Jun 2022Review(s) Completed, Editorial Evaluation Pending
30 Jun 2022Editorial Decision: Revise Major
07 Jul 20221st Revision Received
07 Jul 2022Submission Checks Completed
07 Jul 2022Assigned to Editor
07 Jul 2022Reviewer(s) Assigned
23 Jul 2022Review(s) Completed, Editorial Evaluation Pending
23 Jul 2022Editorial Decision: Accept
Nov 2022Published in Journal of Cardiac Surgery volume 37 issue 11 on pages 3813-3824. 10.1111/jocs.16889