[III-JCKAP6-1-5] Complex Transposition of the Great Arteries: Surgical Approaches and Challenges
Keywords:transposition of the great arteries, LVOT obstruction, aortic root translocation
Complex TGA is a congenital heart disease with ventricular-arterial discordance and left ventricular outflow tract obstruction (LVOTO). It often features a ventricular septal defect (VSD). Without LVOTO, an arterial switch operation (ASO) can correct this condition with favorable long-term outcomes. However, significant LVOTO requires different repairs, divided into aortic root translocation (ART) and non-ART methods such as the Rastelli, REV, and pulmonary root translocation.In contrast to non-ART, ART moves the aortic root posteriorly, facilitating efficient blood flow through the LVOT, minimizing RVOT compression by the chest wall, and simplifying VSD baffling. Despite these benefits, ART poses challenges: risk of aortic regurgitation and coronary malperfusion, increased surgical complexity, and operative time leading to myocardial protection issues and postoperative bleeding.The key to ART is maintaining aortic root geometry. For this, complete repair of coronary artery button defects with the patient's coronary button or pericardial patch and the connection of the aortic root to the ascending aorta should be first performed. This should be followed by VSD baffling and the completion of reimplanting the remaining coronary artery buttons while filling the blood in the aortic root and ensuring its integrity. This approach could provide surgeons with surgical competence. This lecture will introduce the aortic root reconstruction-first technique of ART for complex TGA.