<i>In vitro</i>evaluation of physiological spiral anastomoses for the arterial switch operation in simple transposition of the great arteries: a first step towards a surgical alternative?

Sievers, Hans‐Hinrich; Scharfschwerdt, Michael; Putman, Léon M.

doi:10.1093/icvts/ivv114

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…Postoperatively, the main PA crosses in front of the neoaortic root in a manner similar to that observed in normal hearts (Fig. 3 ) [ 12 ]. The PA bifurcation was preserved with an angle approximating that seen pre-operatively.…”

Section: Resultsmentioning

confidence: 59%

“…3 ). Postoperatively, the normal crossing of the PA and neo-aorta [ 12 ] was restored with the main PA arising from the neo-RVOT (Fig. 3 ).…”

Section: Resultsmentioning

confidence: 99%

“…The pattern of flow in the heart and great vessels is closely linked to the morphology and topology of the chambers [ 12 ] and coupled to myocardial contraction, in what is termed morphodynamism [ 21 , 22 ]. Effective repair of complex congenital defects should aim at preserving or restoring morphodynamism, and ventriculo-ventricular interaction, rather than introducing additional abnormalities, such as sudden change in luminal diameter or interference with contractile function (Video 1).…”

Section: Discussionmentioning

confidence: 99%

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Novel concepts and early results of repairing common arterial trunk

Yacoub

Hosny

Afifi

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Common Arterial Trunk (CAT) continues to have a very poor prognosis globally. To address that, we have developed a novel technique targeting key concepts for the correction of all components of the anomaly, using autologous arterial tissue. This aims to enhance results, availability worldwide, and importantly to avoid the need for repeated reoperations. METHODS From January 2019 to 4 January 2021, all patients with isolated CAT had repair of the defect using autologous arterial trunk tissue with direct right ventricle (RV) to pulmonary artery (PA) connection. Clinical outcomes, follow-up which included multi-slice computed tomography 3D segmentation and 4D cardiovascular magnetic resonance flow, are presented. RESULTS Twenty patients were included in the study (median age 4.5 months). There were 2 hospital deaths due to systemic infection and pulmonary hypertensive crisis, respectively. Following discharge all patients remained asymptomatic with no signs of heart failure and improved pattern of growth (median follow-up: 8 months). Early postoperative 3D segmentation showed a conical shaped neo-right ventricular outflow chamber connecting the body of the RV to the main PA through a valveless ostium, and normal crossing of PA and neo-aorta. 4D cardiovascular magnetic resonance pattern of flow showed normal rapid laminar flow through the atrioventricular valves followed by a vortex towards the outflow tracts. There was laminar flow through the neo-aorta and neo-PA with velocity not exceeding 2.5 m/s. The PA regurgitant fraction was 25 ± 5% and was limited to early diastole. CONCLUSIONS The initial results of utilizing the key concepts, using autologous arterial tissue for the repair of CAT, are encouraging, both clinically and by multimodality imaging.

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Section: Resultsmentioning

confidence: 59%

“…3 ). Postoperatively, the normal crossing of the PA and neo-aorta [ 12 ] was restored with the main PA arising from the neo-RVOT (Fig. 3 ).…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Novel concepts and early results of repairing common arterial trunk

Yacoub

Hosny

Afifi

et al. 2021

European Journal of Cardio-Thoracic Surgery

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“…Refined operative techniques such as deliberately dissecting the arch and pulmonary arteries till the hilum to get more length of the great arteries as well as the transfer of the left coronary orifice as deep and posterior as possible in the related sinus of the pulmonary root including special anastomotic techniques like the trap door may be of advantage to prevent potential left coronary artery distortion by the rotation process of the neo-pulmonary root. In some cases an elongation of the pulmonary artery with a strip of autologous pericardium may allow for tension and torsion free anastomosis 6 , 7 .…”

Section: Discussionmentioning

confidence: 99%

4D flow streamline characteristics of the great arteries twenty years after Lecompte and direct spiral arterial switch operation (DSASO) in simple TGA

Sievers

Putman

Kheradvar

et al. 2016

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Transposition of the great arteries (TGA) is caused by discordance between the great arteries and the ventricles. If left untreated, this anomaly has a disastrous perspective. More recent surgical approach for correction includes the Lecompte technique in which the pulmonary bifurcation is transposed anterior to the aorta, which may be less physiologic. Although the early results are excellent, there is potential for future problems involving the great arteries and semilunar valves1. These potential problems necessitate the development of other improved surgical techniques2. Here we report an MRI 4D flow study related to a case of simple TGA whose primary surgical correction – direct spiral arterial switch operation (DSASO) – was performed twenty years ago in an attempt to restore physiologic arrangement among the great arteries and semilunar valves.

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“…In vitro studies have demonstrated that a tension-or torsion-free repair of TGA is possible if the great vessel roots are arranged anterior-posteriorly or oriented up to a 35-degree angle. 19) Therefore, the configuration of great vessels or the great vessel angle can predict the outcome of ASO, as far as the tensionfree repair is concerned. This angle is equally important in post-operative follow-up.…”

Section: Great Vessel Relationshipmentioning

confidence: 99%

Role of Computed Tomography in Postoperative Follow-up of Arterial Switch Operation

Kumar

Bhatia

2021

J Cardiovasc Imaging

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An arterial switch operation (ASO) is the standard treatment for infants and children born with D-loop transposition of the great arteries. During the ASO, the great vessels are transected from the native roots, switched and anastomosed with the opposite roots. This is accompanied by the relocation of the pulmonary artery anterior to the aorta by using the LeCompte maneuver and the translocation of coronary arteries to the neo-aorta. ASO has led to improved overall survival, and postoperative mortality is rare. Despite the improved outcomes, several postoperative sequelae may occur, and therefore patients require longterm follow-up. Computed tomography (CT) has emerged as a robust imaging modality in pre and postoperative evaluation of a variety of congenital heart disorders including ASO. Unlike echocardiography and cardiovascular magnetic resonance, CT is not hindered by a poor acoustic window, metallic devices or the need for sedation or general anesthesia. CT with advanced three-dimensional postprocessing techniques, high pitch scanning, wider detector system, electrocardiogram-dependent modulation and dose-reduction strategies is invaluable in assessing the postoperative complications after ASO.

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In vitroevaluation of physiological spiral anastomoses for the arterial switch operation in simple transposition of the great arteries: a first step towards a surgical alternative?

Abstract: In this TGA model, it was possible to perform tension- and torsion-free arterial anastomoses for ASO without artificial material, when the aortic root was positioned from 0° up to 35° to the right of the pulmonary root. Evaluation of coronary transfer is the next step.

Cited by 4 publications

References 18 publications

Novel concepts and early results of repairing common arterial trunk

Novel concepts and early results of repairing common arterial trunk

4D flow streamline characteristics of the great arteries twenty years after Lecompte and direct spiral arterial switch operation (DSASO) in simple TGA

Role of Computed Tomography in Postoperative Follow-up of Arterial Switch Operation

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