Work

Coronary ostial plasty using femoral artery homograft following arterial switch operation

Year: 2025

Type: article

Abstract: Objective: The arterial switch operation (ASO) is the standard repair for d-transposition of the greater arteries, although coronary reimplantation remains technically complex and carries the risk of both early and late complications. Coronary ostial plasty for late stenosis has been described using various patch materials, each with its own advantages and limitations. However, the optimal patch material remains unclear. Methods: We report 2 cases of symptomatic late left main coronary artery (LMCA) stenosis after ASO in young adults with complex coronary artery. Both patients underwent coronary ostial plasty in which a femoral artery homograft patch was used. The patients' preoperative presentation, imaging findings, operative details, and postoperative course are reviewed. Results: Case 1 was a 22-year-old man with a single coronary artery arising from the right anterior sinus and >75% LMCA ostial stenosis. Case 2 was a 25-year-old young man with interarterial LMCA atresia and collateralization from a dominant right coronary artery. In both cases, surgical repair involved extending the aortotomy into the LMCA and performing ostial plasty using a femoral artery homograft patch. Both patients had uneventful recoveries and remain asymptomatic with excellent functional status. Conclusions: Late coronary artery stenosis is a recognized complication after ASO, particularly in patients with complex coronary anatomy. Although multiple patch materials have been used for ostial plasty, each has drawbacks. Femoral artery homograft may represent a promising alternative in these challenging anatomical settings.

Source: JTCVS Techniques

DOI: 10.1016/j.xjtc.2025.10.013