Percutaneous Management of Coronary Button Kinking After Emergency Aortic Root Replacement

Surgical management of type A acute aortic dissection by the Bentall procedure involves attachment of the native coronary arteries to a synthetic valved-graft conduit (mechanical or biological aortic valve). In patients with normal anatomy and with careful surgical technique, formation of coronary buttons has been successful, and anastomotic complications after this procedure are rare. However, we describe the development of postoperative myocardial ischemia in a 46-year-old man caused by coronary button kinking after the Bentall procedure and reflect how one may avoid returning to the operating theater and still achieve a good outcome.