[An alternative technique for coronary reattachment in aortic root replacement--the "shell" button technique].
A modified technique to the reattachment of the coronary ostia in the aortic root replacement is described. The left coronary ostium is excised semicircumferentially in an aortic button with its subostial quarter remained as a joint. A collagen impregnated 10-mm Dacron interposition tube graft is sutured rectangularly to the face of the button with the interrupted pledgeted horizontal mattress sutures all running through the button wall in outside-in fashion. The other end of the graft is beveled and sutured end-to-side cephalad to the aortic conduit in order to join each other with straightness assuring the distance between the right coronary button and the aortic conduit to be anastomosed directly. The left coronary button can incline passively with the long axis of the coronary graft, like a "shell", and this allows equivalent distribution of tension on the anastomosis and a straightness of the graft to create the laminar flow in it. The right coronary button is anastomosed to the aortic conduit opposite the ostium with a running over-and-over suture. This procedure has been used in a 35-year-old male with annuloaortic ectasia caused by Marfan's syndrome complicated with type A acute aortic dissection. The patient discharged on the 26th postoperative day without any complications nor angiographic problems. We found this procedure useful in terms of the security of the coronary anastomosis and geometrical arrangement of the conduits.