Discussion
COA is one of the complications after ARR. 1, 2Previous studies have reported that COA was frequently seen in patients
with MFS. 1, 2
To avoid the recurrence of COA, the reconstruction method of coronary
ostium is important. Previous reports have proposed two important points
as follows. First, reducing the tension on the anastomosis.4 Second, removing the diseased aortic wall around
coronary ostium as much as possible. 3 To reduce the
tension, complete resection adhered tissue around coronary button is
needed. However, the remnant tissue around coronary ostium often tightly
adhered around tissues like this case. Thus, we could not select
coronary ostium reconstruction using coronary button technique. Although
the graft interposing method like Cabrol’s technique are helpful4, we need to use the necessary bare minimum of
diseased aortic wall around the coronary buttons for anastomosis.
Therefore, we considered that the graft interposing technique were not
suitable for this patient to prevent the recurrence of COA.
CABG is established and useful technique when we could not employ
anatomical reconstruction of coronary ostium. We performed short segment
CABG to LMT and proximal RCA using RA, because LMT and proximal RCA
could be exposed easily in the same operative field, and it is very easy
to harvest the enough length of RA graft for short segment CABG rather
than the internal mammary artery during reoperation. In addition, RA
graft has not only an enough flow capacity immediately after coronary
reconstruction, but also the excellent 20-years patency rate especially
when the conduit is used to a vessel with > 90% stenosis.5 The satisfactory patency rate of RA graft was
reported similar to that of internal mammary artery and superior to that
of saphenous vein. 5