Retrograde Percutaneous Re-Anastomosis of Occluded Right Coronary Artery Through a Synthetic Bentall Graft

BACKGROUND: In some Bentall surgeries, a coronary artery is not reimplanted but instead grafted. CASE SUMMARY: A 49-year-old patient who underwent prior Bentall surgery using a synthetic root, mechanical valve, and saphenous vein graft (SVG) to the right coronary artery (RCA) developed non-ST-segment elevation myocardial infarction due to graft failure. We performed retrograde recanalization of the native RCA and created a neo-ostium through the graft using electrosurgery, high-pressure and molding balloons, and stenting without complications. DISCUSSION: Success was achieved through careful planning using coronary computed tomography angiography and execution using latest available techniques and technology. NOVELTY: This is the first reported percutaneous re-anastomosis of a coronary to a synthetic aortic graft. TAKE-HOME MESSAGE: Failure of an SVG attached to a non-reimplanted coronary post Bentall is a challenging clinical situation. We could re-anastomose the RCA to the synthetic Bentall graft using retrograde, electrosurgery, novel balloon techniques, and stenting.