Coronary ostial aneurysms after composite graft replacement.

Area of Science:

• Cardiovascular Surgery
• Aortic Surgery
• Marfan Syndrome

Background:

• Coronary ostial aneurysms are a rare but serious complication following composite graft replacement of the ascending aorta and aortic valve.
• Patients with connective tissue disorders like Marfan syndrome may be at increased risk.
• The precise etiology of these aneurysms post-aortic reconstruction is not fully understood.

Observation:

• This report details two cases of Marfan syndrome patients who developed coronary ostial aneurysms.
• The aneurysms occurred at the coronary anastomosis sites after ascending aorta and aortic valve replacement with composite grafts.
• A presumed cause was the creation of oversized "windows" in the aortic graft material.

Findings:

• Both patients with coronary ostial aneurysms were successfully treated with a redo composite graft replacement procedure.
• The study highlights the importance of meticulous surgical technique to prevent graft-related complications.
• Oversized graft windows can lead to exposure of the diseased native aortic wall to blood flow, potentially causing aneurysm formation.

Implications:

• Surgical guidelines should emphasize creating graft windows no larger than the coronary ostium diameter.
• Suturing coronary buttons directly through the ostial rim, rather than the surrounding aortic wall, is crucial.
• Adherence to these technical refinements may reduce the incidence of coronary ostial aneurysms in complex aortic reconstructions.