Coronary stenting after aortic root replacement

We describe a case of severe coronary artery stenosis in a 29-year-old male 1 month after aortic root replacement (ARR). The patient presented with exertional chest pain that progressed to prolonged resting angina and ventricular arrhythmia. Electrocardiography showed ischemic changes suggestive of left coronary artery involvement, and multislice computed tomography angiography confirmed subtotal stenosis at the left main (LM) bifurcation. Urgent percutaneous coronary intervention (PCI) with drug-eluting stent implantation from the LM to the left anterior descending artery was performed using a provisional technique, resulting in improvement of left ventricular ejection fraction from 23% to 55%. The patient was discharged without complications and remained event-free at 6-month follow-up. This case highlights a rare but potentially life-threatening coronary complication after ARR, which may be related to perfusion cannula placement, technical factors during coronary ostial reimplantation, or proliferative reactions to the aortic prosthesis or gelatin-resorcinol-formaldehyde glue. It underscores the need for early recognition and vigilance for coronary ischemia after ARR - even in young patients without prior coronary artery disease - and emphasizes the efficacy of emergency PCI. A multidisciplinary approach is recommended to optimize outcomes in complex postsurgical cardiovascular patients.