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[A modified technic for coronary to graft anastomosis and coronary perfusion in Bentall operation]
Insights
This study introduces a modified Bentall procedure for aortic root repair, improving coronary artery reattachment. The technique demonstrated safe and effective results in patients with annuloaortic ectasia and aortic dissection.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Techniques
Context:
- Bentall procedure is a complex surgery for aortic root aneurysm and dissection.
- Coronary artery reattachment can be challenging, especially with anatomical variations.
- Annuloaortic ectasia and aortic dissection require specialized surgical approaches.
Purpose:
- To describe a modified Bentall procedure for improved coronary artery to graft anastomosis.
- To evaluate the safety and efficacy of this modified technique in patients undergoing aortic root repair.
Summary:
- A modified Bentall operation was performed on 7 patients (6 with annuloaortic ectasia, 1 with type 1 aortic dissection) between 1987 and 1989.
- The technique involved creating side-holes in the composite graft for coronary ostia, facilitating easier and more secure anastomosis.
- Retrograde cold blood cardioplegia via the coronary sinus was employed to enhance safety and ease of procedure.
Impact:
- Postoperative angiography confirmed no coronary artery stenosis or deformity and no suture line leakage.
- All patients achieved excellent outcomes, functioning at NYHA class I post-surgery.
- This modified technique offers a reliable and safe option for complex aortic root reconstructions.
Abstract:
From September 1987 to January 1989, we performed 7 consecutive Bentall operations using a modified technique for the coronary artery to graft anastomosis with a satisfactory result. Six patients with annuloaortic ectasia and one with type 1 aortic dissection underwent the operation. After suturing a composite graft to the aortic annulus, side-holes about 8 mm in diameter were made in the graft at points corresponding to the coronary ostia. Then the graft was cut longitudinally on the side of the non-coronary cusp so as to make operative procedure easier. Four buttressed mattress sutures of 4-0 polypropylene thread were placed in the aortic wall around the coronary ostia and connected to the corresponding part of the graft. These threads were tied and then used for running sutures from inside of the graft. Even in a case where the coronary ostium was close to the aortic annulus, this procedure permitted easy and secure accessibility. Additionally, retrograde continuous cold blood cardioplegia via the coronary sinus made Bentall procedure easier and safer. Postoperative angiography revealed no stenosis or deformity of the coronary artery and no leakage from the suture line. All patients are doing well in NYHA functional class I.