Cobrahead reimplantation of anomalous coronary arteries arising from the left coronary sinus

Cobrahead reimplantation is a novel technique that we have implemented to address an anomalous right coronary artery arising from the left coronary sinus, particularly in patients with a short intramural course. This technique requires complete mobilization of the anomalous vessel, detachment of the right coronary artery from its origin at the aorta and creation of a splay incision or 'cobrahead' within the proximal vessel. This cobrahead apparatus is then utilized to create a wide anastomosis during reimplantation of the vessel in the aorta, minimizing the risk of kinking or stenosis at this site. Our single-centre experience with this method has demonstrated excellent postoperative outcomes with long-term patency of the reimplanted coronary artery. These findings have been reaffirmed with longitudinal follow-up, which has demonstrated improvement in the instantaneous wave-free ratio, resolution of ischaemic symptoms and clearance for resumption of physical activity without restrictions. Furthermore, we have yet to encounter damage to the aortic valve apparatus utilizing this technique, reaffirming its utility in this patient population and its advantages relative to similar operative methods.