Retrograde Percutaneous Re-Anastomosis of Occluded Right Coronary Artery Through a Synthetic Bentall Graft: First-in-Man Case
Abstract
Background: In some Bentall surgeries, a coronary artery is not reimplanted but instead grafted.
Case summary: A 49-year-old patient who underwent prior Bentall surgery using a synthetic root, mechanical valve, and saphenous vein graft (SVG) to the right coronary artery (RCA) developed non-ST-segment elevation myocardial infarction due to graft failure. We performed retrograde recanalization of the native RCA and created a neo-ostium through the graft using electrosurgery, high-pressure and molding balloons, and stenting without complications.
Discussion: Success was achieved through careful planning using coronary computed tomography angiography and execution using latest available techniques and technology.
Novelty: This is the first reported percutaneous re-anastomosis of a coronary to a synthetic aortic graft.
Take-home message: Failure of an SVG attached to a non-reimplanted coronary post Bentall is a challenging clinical situation. We could re-anastomose the RCA to the synthetic Bentall graft using retrograde, electrosurgery, novel balloon techniques, and stenting.
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