The "Button Inside" Technique for the Aortic Root Replacement: A Modified Button Technique

Coronary reimplantation in aortic root surgery: the trapdoor technique for adults

Coronary ostial reimplantation during aortic root replacement is a key stage of the operation. The "button technique" is the most used method, but there are still concerns about the incidence of coronary pseudoaneurysm formation, bleeding, and distortion of the coronary geometry. We describe how we adapted the trapdoor technique, commonly used in the arterial switch operation in children, to reimplant the coronary ostia in adult patients undergoing aortic root replacement.

Proposed modification for valve-sparing aortic root replacement

Valve-sparing aortic root replacement (ARR) is the procedure of choice in young patients with aortic root aneurysm and preserved aortic valve leaflets; however, coronary ostial anastomoses remain an issue. Troublesome bleeding sometimes occurs during surgery, and in the long term, there is a risk of aneurysmal formation in the residual aortic wall of the ostial "button." We describe a technique of valve-sparing ARR wherein each coronary button along with its flange of aortic tissue is implanted within the prosthetic graft used for ARR, thereby eliminating the risk of both immediate surgical bleeding and late coronary button aneurysms.