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

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 valve-sparing 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.

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A modified Piehler technique for aberrant origin of left coronary arteries

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320981489 ◽

2020 ◽

pp. 021849232098148

Author(s):

Kosuke Nakamae ◽

Takashi Oshitomi ◽

Hidetaka Murata ◽

Hideyuki Uesugi

Keyword(s):

Coronary Arteries ◽

Aortic Root ◽

Aortic Root Replacement ◽

Coronary Anomaly ◽

Dacron Graft ◽

Sinus Of Valsalva ◽

Sinus Of Valsalva Aneurysm ◽

Replacement Strategy ◽

Side Hole ◽

Valved Conduit

A bicuspid aortic valve sometimes coincides with a sinus of Valsalva aneurysm having a coronary artery anomaly. A meticulous aortic root replacement strategy is needed in these cases. In a 64-year-old man, the left coronary arteries (LCA) with an aberrant origin were excised together and reattached to the side hole of a valved conduit via a short Dacron graft. To prevent the formation of an aneurysm at the site, a strip of Dacron graft was sutured from outside between the LCA. The procedure for aortic root replacement with a coronary anomaly needs a case-by-case surgical strategy.

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Technique of Aortic Root Reconstruction Using a New Model of Dacron Graft with Prefabricated Coronary Branches

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451400900611 ◽

2014 ◽

Vol 9 (6) ◽

pp. 451-453

Author(s):

Domenico Calcaterra ◽

Robert S. Farivar ◽

Kalpaj R. Parekh ◽

Mohammad Bashir ◽

Karam Karam ◽

...

Keyword(s):

Coronary Arteries ◽

Aortic Root ◽

Surgical Procedure ◽

Prosthetic Graft ◽

Dacron Graft ◽

Significant Morbidity ◽

Technical Challenge ◽

New Model ◽

Valve Sparing

Aortic root reconstruction is a demanding surgical procedure still associated with a significant morbidity. Arguably, the most demanding aspect of the operation is reestablishing continuity between the prosthetic graft replacing the aortic root and the coronary arteries. With the objective of simplifying the possible challenges of coronary reimplantation, we designed a new model of aortic root graft with prefabricated coronary branches. We used this technique in 8 patients (6 males, 2 females; mean age, 54 years). There were 6 modified Bentall procedures and 2 valve-sparing root replacements with the “reimplantation” technique. There was no mortality or morbidity related to the use of this new prosthetic graft. Our purpose was to report in detail the technique of aortic root reconstruction using this new graft with prefabricated coronary branches. The use of this graft may simplify the procedure and offer a valuable tool for aortic root reconstruction in cases where the reimplantation of the coronary buttons may represent a technical challenge.

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Aortic root aneurysm. Diagnosis and treatment

JAMA ◽

10.1001/jama.197.2.133 ◽

1966 ◽

Vol 197 (2) ◽

pp. 133-134 ◽

Cited By ~ 2

Author(s):

H. Najafi

Keyword(s):

Aortic Root ◽

Diagnosis And Treatment ◽

Aortic Root Aneurysm

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Dilatation of the entire thoracic aorta in patients with bicuspid aortic valve: a magnetic resonance angiography study

VASA ◽

10.1024/0301-1526.34.3.181 ◽

2005 ◽

Vol 34 (3) ◽

pp. 181-185 ◽

Cited By ~ 12

Author(s):

Westhoff-Bleck ◽

Meyer ◽

Lotz ◽

Tutarel ◽

Weiss ◽

...

Keyword(s):

Magnetic Resonance ◽

Magnetic Resonance Angiography ◽

Aortic Valve ◽

Pulmonary Artery ◽

Aortic Arch ◽

Thoracic Aorta ◽

Aortic Root ◽

Ascending Aorta ◽

Descending Aorta ◽

Severe Aortic Regurgitation

Background: The presence of a bicuspid aortic valve (BAV) might be associated with a progressive dilatation of the aortic root and ascending aorta. However, involvement of the aortic arch and descending aorta has not yet been elucidated. Patients and methods: Magnetic resonance angiography (MRA) was used to assess the diameter of the ascending aorta, aortic arch, and descending aorta in 28 patients with bicuspid aortic valves (mean age 30 ± 9 years). Results: Patients with BAV, but without significant aortic stenosis or regurgitation (n = 10, mean age 27 ± 8 years, n.s. versus control) were compared with controls (n = 13, mean age 33 ± 10 years). In the BAV-patients, aortic root diameter was 35.1 ± 4.9 mm versus 28.9 ± 4.8 mm in the control group (p < 0.01). The diameter of the ascending aorta was also significantly increased at the level of the pulmonary artery (35.5 ± 5.6 mm versus 27.0 ± 4.8 mm, p < 0.001). BAV-patients with moderate or severe aortic regurgitation (n = 18, mean age 32 ± 9 years, n.s. versus control) had a significant dilatation of the aortic root, ascending aorta at the level of the pulmonary artery (41.7 ± 4.8 mm versus 27.0 ± 4.8 mm in control patients, p < 0.001) and, furthermore, significantly increased diameters of the aortic arch (27.1 ± 5.6 mm versus 21.5 ± 1.8 mm, p < 0.01) and descending aorta (21.8 ± 5.6 mm versus 17.0 ± 5.6 mm, p < 0.01). Conclusions: The whole thoracic aorta is abnormally dilated in patients with BAV, particularly in patients with moderate/severe aortic regurgitation. The maximum dilatation occurs in the ascending aorta at the level of the pulmonary artery. Thus, we suggest evaluation of the entire thoracic aorta in patients with BAV.

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