Congenital Heart Surgeons' Society

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Simplified Aortic Arch Reconstruction In Complex Transposition Of The Great Arteries Using The Swing-back Technique
Peter C. Kouretas, MD, PhD, Shunji Sano, MD, PhD.
UCSF, San Francisco, CA, USA.

Surgical repair of complete transposition of the great arteries with aortic arch obstruction presents specific surgical challenges. Several surgical options exist to address the size discrepancy between the ascending aorta and main pulmonary trunk as well as the complex aortic arch anatomy. We present a simplified approach for aortic arch reconstruction in the setting of transposition of the great arteries (TGA) using a swing-back technique. Our patient is a 4 day old neonate, weighing 2.6 kg, who presents with the diagnoses of TGA, VSD, coarctation of the aorta with hypoplastic transverse arch. There was significant size discrepancy between the ascending aorta (6mm) and pulmonary trunk (15mm). Coronary artery anatomy was normal. After going on CPB and cooling to 25 degrees, the CoA segment is transected and all ductal tissue removed under low-flow cerebral perfusion. The ascending aorta is then transected and swung-back and anastomosed to the descending aorta. A counter-incision is then made on the undersurface of the ascending aorta and anastomosed to the neo-aortic trunk after the coronary buttons have been re-implanted. The advantages of the swing-back include decreased ischemic time, use of only autogenous tissue with potentially reduced recoarctation rates and easy application to other transposition complexes with aortic arch obstruction.