Revial of rapid 2-stage arterial switch procedure for transposition of great arteries

Abstract

Objective: To minimize invasiveness for extended resection and end to end anastomosis of aortic coarctation.Methods: 27 consecutive patients (median age 8 days; median weight 3.3 kg) undergoing surgical repair for aortic coarctation from June 2002 to September 2003 were approached through a left posterior minithoracotomy with reduced invasiveness : 1) lattisimus dorsi was partially split (not at all in last 3 cases ), the serratus anterior was not divided 2) thorax was entered through a subperiosteal reflection of the intercostal muscles and 3) thoracic aorta was approached extrapleurally. Extended resection of stenotic isthmus and repair was performed in a standard manner. 4 patients were subjected to left subclavian arter T translocation for distal arch augmentation, while 6 underwent additional pulmonar Tarter T banding. Periosteum was readapted to the rib with continuous absorbable sutures. The median aortic clamp and operative times were 24 (range 14 35) and 90 (range 65 165) rains respectively.Results: All patients survived the operation without significant complications. One patient developed chylothorax needing exploration and suture closure of the lymphatic fistula. Postop echo showed no significant gradients across the neoisthmus.Conclusions: Reducing invasiveness (nondivision of muscles, subperisteal entr T and extrapleural appraoch) is feasible and safe and provides adequate exposure for isthmus resection and repair. It reduces postoperative morbidity related to division of muscles, handling of the lung and opening of the pleura. It produces good cosmetic result. It may prevent formation of systemic to pulmonar T parenchymal collaterals in patients with associated cyanotic diseases.A study of RVOT obstruction over eleven [----] years-JIPMER experience