A uniform surgical technique for transfer of both simple and complex patterns of the coronary arteries during the arterial switch procedure

The arterial switch operation1 has now become the surgical treatment of choice for those patients born with transposition, specifically the combination of concordant atrioventricular and discordant ventriculo-arterial connections. For those working in experienced centres, the operation is now a stable and well-controlled procedure. The gathering of the necessary experience to achieve such control proceeds through two different stages. The first is the familiarity gained during the surgical transfer of the coronary arteries in those patients with the usual anatomic pattern. The second step is gain the expertise so as to cope with the more complex arrangements, in which the major coronary arteries have not only an unusual origin from the aortic sinuses, but also an unexpected epicardial course relative to the arterial pedicle. There can still be a steep learning curve as the surgeon corrects those patients with the more complex arrangements. In this review, we discuss a simplified but uniform technique for surgical transfer that permits relocation of the coronary arteries irrespective of their sinusal origin or their epicardial course. The technique has been used for more than 15 years in Hopital Marie Lannelongue in Paris,2–5 and proved its worth during the initial experience of the Senior Author (FLG) in two new centres, namely the Universitat Krankenhaus Eppendorf, Hamburg, and the Children's Hospital, Denver.