Modified arterial switch operation by sharing the common wall between the great arteries

Background: Suprapulmonary stenosis and coronary arterial obstruction still remain as problems after an arterial switch operation (ASO). We used a mod ified ASO applying the common wall and in situ transfer techniques to impro ve the current procedure. Methods: From October 1996 to December 1997, 11 babies aged 6 days to 3 mon ths with transposition of die great arteries underwent a modified ASO which included sharing the common wall between the great arteries until above th e anterior neoaortic suture-line for coronary and pulmonary artery reconstr uction. Coronary arteries were of usual type in three cases, juxtacommissur al origin in five, and a high takeoff in one; all were redirected almost in situ. Results: There was no early death (< 30 d), coronary or bleeding problems. One late death occurred after a repeat surgery for suprapulmonary stenosis. This was caused by upward stretching of the left pulmonary artery, which w as placed above the high left-sided neoaortic anastomosis for in situ trans fer of the high takeoff coronary arteries. Intraluminal growth of the adven titia also contributed to suprapulmonary stenosis, which decreased signific antly when the common wall adventitia was cleaned in the last two cases we operated on. Ten patients were doing well at follow-up (30.9 <plus/minus> 5 .2 mo). Conclusions: This modified ASO by common wall and in situ transfer might av oid coronary kinking and lessen the chance of postoperative bleeding. To av oid suprapulmonary stenosis, common wall adventitia inside the pulmonary pa thway should be cleaned, and the left and right pulmonary arteries should a lso be kept in situ as possible as in corollary redirection.