Aortic valve replacement in a patient with a patent internal thoracic artery graft

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Thoracic Surgery

Background:

• Repeat open-heart surgery following coronary artery bypass grafting (CABG) presents unique myocardial protection challenges.
• Maintaining the integrity of patent grafts, particularly the left internal thoracic artery (LITA) to the left anterior descending (LAD) coronary artery, is crucial but complex.
• Aortic valve replacement (AVR) in patients with prior CABG requires careful consideration of myocardial preservation strategies.

Observation:

• A patient underwent aortic valve replacement 18 months after initial coronary artery revascularization.
• The procedure involved beating-heart aortic valve replacement, avoiding cardiopulmonary bypass.
• Continuous retrograde coronary sinus perfusion was employed for myocardial protection.
• Careful surgical technique ensured no dissection of patent grafts, including LITA and saphenous vein grafts.

Findings:

• Successful beating-heart aortic valve replacement was achieved in a patient with prior CABG and patent grafts.
• Retrograde coronary sinus perfusion provided effective myocardial protection during the procedure.
• Preservation of LITA and saphenous vein grafts was accomplished without compromising surgical goals.

Implications:

• This case suggests that beating-heart AVR with retrograde coronary sinus perfusion is a viable option for myocardial protection in select patients with prior CABG.
• The findings highlight the importance of meticulous surgical technique to avoid graft injury in reoperative cardiac surgery.
• This approach may offer an alternative strategy for managing complex cardiac conditions in patients with extensive prior revascularization.