“Legs” technique for management of widely separated coronary arteries during ascending aortic repair

Widely separated coronary arteries with significantly diseased tissue continues to challenge surgeons repairing ascending aortic aneurysms. Occasional troublesome leaks around coronary ostial anastomoses and Cabrol graft thrombosis prompted a change of our operative management of this condition. Collagen-impregnated 8-mm “legs” grafts are used to connect the coronary arteries to the composite graft. Ten patients, aged 14 to 70 years, underwent the operation. The first patient is 15 years after operation and is symptom free. One patient died of an arrhythmia 1 month after discharge. Eight patients are living and well 1 1/2 to 4 years postoperatively. Advantages of direct interposition (legs) grafts are as follows: the coronary arteries are separately perfused and the risk of catastrophic thrombosis from a longer high-volume graft is eliminated. Problems with coronary ostial mobilization are avoided. The technique allows full visualization and hemostatic suture line testing with cardioplegia before aortic declamping. Space constraints with reoperations are easily managed, whereas other techniques may result in graft compression on refilling of the heart and termination of bypass. The technique is carried out with ease and reproducibility, and the availability of new graft material has made it our treatment of choice for ascending aortic composite graft replacement.