Coronary reimplantation in aortic root replacement: a method to avoid tension

Westaby, Stephen; Katsumata, Takahiro; Vaccari, Giuseppe

doi:10.1016/s0003-4975(99)00147-2

“…5 If it is not possible to perform coronary implantation, the options include coronary bypass, coronary extension using a Dacron conduit, or pericardial hood extension of the coronary buttons. 1 In our patient, the LAD and LCX arose separately, and both were included in a larger than usual button. We kept the excess of the aortic wall, which was used in a similar fashion to that described by Westaby and colleagues.…”

Section: Discussionmentioning

confidence: 74%

Aortic root replacement with absent left-main coronary artery: How to do it

Saha

¹

,

Parate

²

,

Jagiasi

³

2013

Asian Cardiovasc Thorac Ann

0

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“…The occurrence of ventricular dysfunction, perioperative myocardial infarction, or surgical bleeding depends on the technical difficulty of coronary reimplantations [3-5, 11, 13]. Damage to the coronary buttons during mobilization and tension or kinking after completion of the anastomosis can cause coronary malperfusion [3,4,[13][14][15]. These mechanisms are illustrated in detail by Elefteriades' group in their report describing "rescue coronary artery bypass grafting" to treat acute coronary insufficiency after ARR ( Figure 2) [4,16].…”

Section: Surgical Techniquementioning

confidence: 99%

“…For these reasons, different techniques have been proposed to reduce the rate of complications associated with coronary reimplantation. For instance, Westaby and colleagues propose a technique using a "pericardial hood" extension added to the right coronary anastomosis ( Figure 3A) [14] to avoid kinking or tension, whereas others advocate the use of a coronary vein bypass interposed between the main aortic graft and the right coronary button [2]. The Cabrol reconstruction represents a more radical approach to the problem [19] and is meant to obviate the challenges of coronary reimplantation when mobilization of the coronaries is cumbersome [2,13,[17][18][19].…”

Section: Surgical Techniquementioning

confidence: 99%

Aortic Root Reconstruction with a New Dacron Graft Featuring Prefabricated Coronary Side Branches

Calcaterra¹,

Jazayeri²,

Parekh³

et al. 2017

aorta

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Background: Coronary button reimplantation can represent a technical challenge of aortic root reconstruction that can be associated with significant morbidity and mortality. With the goal of simplifying coronary reimplantation and reducing the incidence of related complications, we designed a new Dacron graft with prefabricated coronary branches to minimize coronary artery mobilization and prevent the potential mechanical complications of reattachment to the body of the graft. Methods: Between June 2010 and May 2012, we implanted the graft in eight patients (six males, two females) ranging in age from 42-68 years (mean, 54 years). Six procedures were modified Bentall reconstructions, and two procedures were valvesparing root replacements using the reimplantation technique. Results: There were no complications and no morbidity or mortality related to coronary reattachment. All patients were alive and doing well at a mean follow-up of 26 months (range, 17-38 months). At an extended mean follow-up of 42 months (range, 25-56 months), one patient died of stroke-related complications. No radiologic or clinical evidence of impairment of coronary perfusion was identified in any patient. Conclusions: The use of this new graft model may simplify the technique of root reconstruction and potentially lower the incidence of mechanical complications related to coronary button reimplantation.

show abstract

“…Damage to the coronary buttons during mobilization and tension or kinking after completion of the anastomosis can cause coronary malperfusion [3,4,[13][14][15]. These mechanisms are illustrated in detail by Elefteriades' group in their report describing "rescue coronary artery bypass grafting" to treat acute coronary insufficiency after ARR ( Figure 2) [4,16].…”

Section: Surgical Techniquementioning

confidence: 99%

“…For these reasons, different techniques have been proposed to reduce the rate of complications associated with coronary reimplantation. For instance, Westaby and colleagues propose a technique using a "pericardial hood" extension added to the right coronary anastomosis ( Figure 3A) [14] to avoid kinking or tension, whereas others advocate the use of a coronary vein bypass interposed between the main aortic graft and the right coronary button [2]. The Cabrol reconstruction represents a more radical approach to the problem [19] and is meant to obviate the challenges of coronary reimplantation when mobilization of the coronaries is cumbersome [2,13,[17][18][19].…”

Section: Surgical Techniquementioning

confidence: 99%

Aortic Root Reconstruction with a New Dacron Graft Featuring Prefabricated Coronary Side Branches

Calcaterra

¹

,

Jazayeri

²

,

Turek

³

et al. 2017

Aorta

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Background: Coronary button reimplantation can represent a technical challenge of aortic root reconstruction that can be associated with significant morbidity and mortality. With the goal of simplifying coronary reimplantation and reducing the incidence of related complications, we designed a new Dacron graft with prefabricated coronary branches to minimize coronary artery mobilization and prevent the potential mechanical complications of reattachment to the body of the graft. Methods: Between June 2010 and May 2012, we implanted the graft in eight patients (six males, two females) ranging in age from 42-68 years (mean, 54 years). Six procedures were modified Bentall reconstructions, and two procedures were valvesparing root replacements using the reimplantation technique. Results: There were no complications and no morbidity or mortality related to coronary reattachment. All patients were alive and doing well at a mean follow-up of 26 months (range, 17-38 months). At an extended mean follow-up of 42 months (range, 25-56 months), one patient died of stroke-related complications. No radiologic or clinical evidence of impairment of coronary perfusion was identified in any patient. Conclusions: The use of this new graft model may simplify the technique of root reconstruction and potentially lower the incidence of mechanical complications related to coronary button reimplantation.

show abstract

Coronary reimplantation in aortic root replacement: a method to avoid tension

Cited by 13 publications

References 5 publications

Aortic root replacement with absent left-main coronary artery: How to do it

Aortic root replacement with absent left-main coronary artery: How to do it

Aortic Root Reconstruction with a New Dacron Graft Featuring Prefabricated Coronary Side Branches

Aortic Root Reconstruction with a New Dacron Graft Featuring Prefabricated Coronary Side Branches

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