Use of saphenous vein to extend and relocate coronary arteries: clinical experience during extensive reconstructive operations of the aortic root.

Eight patients with advanced disease of the aortic root involving the origins of the coronary arteries have been operated on with resection of the entire aortic root including the ostia of the coronary arteries. Reconstruction was performed by insertion of a composite prosthesis; extension and relocation of the proximal portion of the coronary arteries was accomplished with saphenous vein segments. Two patients had infected aortic valve prostheses, three patients had acute aortic dissection and three had annuloaortic ectasia. Seven of eight patients survived the operation, the only operative death occurring in a patient submitted to an operation in a shock state following rupture of the aorta. There was, however, a high incidence of subsequent late deaths resulting from continued infection and from central circulatory failure. An analysis of this series of patients suggests the possibility that a reconstruction that relocates and extends the proximal portion of the coronary circulation may provide a total blood flow that is inadequate or inappropriate, and further suggests that the methods used in the reconstruction of the proximal circulation may be critical to the prevention of myocardial hypoperfusion.