Direct reimplantation of a transected coronary artery in acute type A aortic dissection: a case report

Background: Retrograde aortic root dissection toward the coronary ostium is uncommon, and acute myocardial ischemia is a potentially fatal condition in this situation. Repairing dissected coronary arteries to prevent myocardial malperfusion is difficult and we introduce our technique with case presentation. Case presentation: A 52-year-old male patient was admitted for acute type A aortic dissection. Circumferential detachment of the right coronary artery (RCA) ostium was detected intraoperatively. The proximal RCA was dissected, the intimal RCA was circumferentially detached with inner intussusception, and only adventitia was partially connected to the aortic root. Instead of performing coronary artery bypass grafting surgery to the RCA, direct RCA implantation to the ascending graft was performed after repairing the dissected lumen of the proximal RCA. Cardiopulmonary bypass weaning was smooth, and no complications related to the RCA were observed. Conclusion: Repairing dissected coronary artery at retrograde aortic root dissection is feasible option.