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Aortic valve replacement after midline-crossed internal thoracic artery grafting
Hiroshi Okamoto1, Akinori Tamenishi, Yutaka Itoh
1Department of Thoracic and Cardiovascular Surgery, Yokkaichi City Hospital, 2-22-37 Shibata, Yokkaichi 510-8567, Japan.
The Japanese Journal of Thoracic and Cardiovascular Surgery : Official Publication of the Japanese Association for Thoracic Surgery = Nihon Kyobu Geka Gakkai Zasshi
|November 14, 2002
Summary
Median sternotomy poses risks for patients with internal thoracic artery grafts. A novel "staircase" thoracotomy approach successfully enabled aortic valve replacement in two patients, preserving graft integrity.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Valve Surgery
Background:
- Median sternotomy is a standard approach for aortic valve replacement but can compromise patent internal thoracic artery (ITA) grafts, particularly those supplying the left anterior descending artery.
- Internal thoracic artery grafts are crucial for coronary artery bypass grafting, and their integrity is paramount during cardiac procedures.
Observation:
- The presence of a patent right internal thoracic artery graft, previously anastomosed to the left anterior descending coronary artery, presented a surgical challenge for aortic valve replacement.
- Two male patients with these specific graft configurations were considered for aortic valve replacement.
Findings:
- A modified "staircase" thoracotomy approach was successfully employed for aortic valve replacement in both patients.
- This technique, combined with hypothermic axillary perfusion and balloon aortic occlusion, effectively protected the patent internal thoracic artery grafts.
- Hemodynamic stability was maintained throughout the procedures.
Implications:
- The "staircase" thoracotomy offers a viable and potentially safer alternative to median sternotomy for aortic valve replacement in patients with patent ITA grafts.
- This approach may reduce the risk of graft injury and associated hemodynamic compromise.
- Further research could explore the broader application of this technique in complex cardiac surgeries involving anteriorly placed grafts.