Key result
Direct RCA reimplantation to an aortic graft in ATAAD succeeds without postoperative complications.
Why the study?
Retrograde aortic root dissection toward the coronary ostium is uncommon and acute myocardial ischemia can be fatal, while repairing dissected coronary arteries to prevent myocardial malperfusion is difficult.
Case Report (n=1)
No
Direct reimplantation of a transected coronary artery to the ascending graft is a feasible option in acute type A aortic dissection with retrograde root dissection.
May support feasibility in select acute type A dissections; hypothesis-generating case report that leaves broader applicability open.
Background: Retrograde aortic root dissection toward the coronary ostium is uncommon, and acute myocardial ischemia is a potentially fatal condition in this situation. Repairing dissected coronary arteries to prevent myocardial malperfusion is difficult and we introduce our technique with case presentation. Case presentation: A 52-year-old male patient was admitted for acute type A aortic dissection. Circumferential detachment of the right coronary artery (RCA) ostium was detected intraoperatively. The proximal RCA was dissected, the intimal RCA was circumferentially detached with inner intussusception, and only adventitia was partially connected to the aortic root. Instead of performing coronary artery bypass grafting surgery to the RCA, direct RCA implantation to the ascending graft was performed after repairing the dissected lumen of the proximal RCA. Cardiopulmonary bypass weaning was smooth, and no complications related to the RCA were observed. Conclusion: Repairing dissected coronary artery at retrograde aortic root dissection is feasible option.
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Song et al. (2023) conducted a case report in Acute type A aortic dissection (n=1). Direct reimplantation of the right coronary artery was evaluated on Surgical success and postoperative complications. Direct reimplantation of a transected right coronary artery to an aortic graft in acute type A aortic dissection was successfully performed without postoperative myocardial infarction or complications.
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