Creation of Coronary Conduit and Neo-Ostium in Previously Ligated Left Coronary Artery With Aortic Homograft.

CASE SUMMARY: A 69-year-old man with a complex cardiac history including prosthetic aortic valve endocarditis with abscess involving the left coronary artery requiring placement of an aortic root homograft with coronary bypass grafting and ligation of the left coronary presented with severe angina following graft failure with severe native vessel disease. Retrograde chronic total occlusion percutaneous coronary intervention techniques, including electrocautery-assisted reentry, were used to connect the disrupted artery with the aortic root.

TAKE-HOME MESSAGE: Chronic total occlusion percutaneous coronary intervention techniques may facilitate reconnection of surgically disrupted coronary arteries with the aortic root.