Retrograde Percutaneous Re-Anastomosis of Occluded Right Coronary Artery Through a Synthetic Bentall Graft:
Stéphane Rinfret1, Moghniuddin Mohammed1, Glen A Henry1
1Georgia Heart Institute of Northeast Georgia Medical Center, Gainesville, Georgia, USA.
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.
