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