The trap-door technique for coronary reimplantation in aortic root surgery

Coronary ostia reimplantation is a crucial stage of every aortic root replacement procedure. The 'button technique' is currently the most used method and it has shown satisfactory outcomes over time. However, coronary reimplantation techniques still present drawbacks such as pseudoaneurysm formation, kinking, bleeding and coronary dehiscence, especially when coronaries are hard to mobilize. We adapted the trap-door technique, commonly used in the arterial switch operations, in order to apply it in older patients requiring an aortic root replacement procedure. The key passage of such a technique is the creation of an L-shaped trap-door flap in the conduit graft in order to produce a cone-like extension of the conduit from which the coronary ostium can arise. We applied this technique in 24 patients over 8 years and we did not experience any complication related to coronary ostia reimplantation. In conclusion, we think that this method could be considered as an alternative technique in order to avoid the use of an interposition vascular graft or a pericardial patch when the conventional reimplantation techniques are not feasible.