Indirect re-implantation of the left coronary artery during aortic surgery.

ABSTRACT

OBJECTIVE: Indirect re-implantation of the left coronary artery (LCA) via an interposition graft simplifies difficult LCA re-implantation during aortic root replacement. Little information exists regarding the results of this technique. In this study, we report our experience. METHODS: Between January 2001 and July 2008, of 82 aortic root replacements, 24 (mean age 48.2 years, 83% male) used the indirect re-implantation technique. All case notes were retrospectively analyzed. Indications for operation were; aortic root aneurysm (n = 16), acute dissection (n = 6), existent homograft calcification (n = 1), failed Ross procedure (n = 1). Reasons for indirect re-implantation were difficult LCA mobilization secondary to previous cardiac surgery (n = 7), short left main stem (n = 6), acute dissection (n = 6), adherence to surrounding tissues (n = 5). All patients had yearly CT or MRI follow-up. RESULTS: Mechanical and tissue valved conduits were implanted in 22 and two patients, respectively. Ten millimeters (n = 17) or 8 mm (n = 7) Dacron grafts were used for LCA re-implantation. Thirty-day mortality was 12.5%. Postoperative complications were re-opening for bleeding (n = 2), pericardial effusion (n = 4), renal failure (n = 1). Over a median follow-up of 26 months (range 4 to 81), one developed a false aneurysm at the right coronary artery anastomosis five months postoperatively, which was subsequently repaired. All interposition grafts remained patent on MRI or CT. There were six late deaths. At median follow-up survival rate was 71%. CONCLUSIONS: The indirect re-implantation of the LCA during aortic root replacements is a reliable, safe, and effective method in dealing with the LCA in difficult circumstances. Survival at 26 months is equivalent to other series of similar patients.