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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
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Aortic valve replacement after previous coronary artery bypass grafting: experience with a simplified approach

D Reber1, M Fritz, W Bojara

  • 1Department of Cardiothoracic Surgery, Bergmannsheil Bochum Ruhr-University Hospital Bochum, Germany. delawer.reber@ruhr-uni-bochum.de

The Journal of Cardiovascular Surgery
|February 20, 2007
PubMed

Insights

This study presents a simplified surgical approach for aortic valve replacement (AVR) after coronary artery bypass grafting (CABG). The technique minimizes disruption, offering a safe option for patients needing repeat valve surgery.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Thoracic Surgery

Background:

  • Aortic valve replacement (AVR) following coronary artery bypass grafting (CABG) presents surgical challenges, especially with a patent left internal thoracic artery (ITA).
  • Protecting the patent graft and ensuring adequate myocardial protection are critical concerns in these complex reoperations.

Purpose of the Study:

  • To evaluate a simplified surgical strategy for AVR in patients with prior CABG.
  • To assess the safety and efficacy of a minimally invasive approach in this high-risk patient group.

Main Methods:

  • A simplified surgical approach was employed in 19 patients undergoing AVR after CABG between 2003 and 2005.
  • The technique involved femoral cannulation and limited aortic and right atrial dissection, preserving the anterior cardiac structures and patent ITA.

Main Results:

  • The mean interval between CABG and AVR was 6.5 years.
  • Mean operating time was 267 minutes, with a cross-clamp time of 63 minutes.
  • One perioperative death occurred due to heart failure; other patients had uneventful postoperative courses.

Conclusions:

  • The simplified surgical approach for AVR after CABG is a viable and safe option.
  • Careful patient selection and re-evaluation of indications for AVR in CABG patients are recommended.
Abstract

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