A simple technique for aortic valve replacement in patients with a patent left internal mammary artery bypass graft

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery Techniques
• Aortic Valve Disease

Background:

• Aortic valve replacement (AVR) presents unique challenges in patients with a patent left internal mammary artery (LIMA) graft.
• Dissection of the LIMA graft and achieving adequate myocardial protection are significant surgical hurdles.

Purpose of the Study:

• To present a simplified surgical technique for AVR in patients with a patent LIMA graft.
• To address the difficulties in myocardial protection and LIMA graft handling during AVR.

Main Methods:

• Description of a novel technique for aortic valve replacement performed on a beating heart.
• Implementation of continuous coronary perfusion to ensure myocardial protection during the procedure.
• Focus on simplified dissection and management of the LIMA graft.

Main Results:

• The described technique facilitates AVR in patients with a patent LIMA graft.
• Continuous coronary perfusion aids in maintaining myocardial viability.
• The method simplifies the surgical approach, potentially reducing operative complexity.

Conclusions:

• This technique offers a viable and simplified solution for aortic valve replacement in patients with a patent left internal mammary artery graft.
• Continuous coronary perfusion is effective in myocardial protection during beating heart AVR in this cohort.
• The approach potentially improves outcomes for a challenging patient group.