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Updated: Jun 10, 2026
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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
[Aortic valve replacement using the "no-touch technique" for a patent internal thoracic artery]
Hironobu Morimoto1, Shogo Mukai, Shogo Obata
1Department of Cardiovascular Surgery, Fukuyama Circulation Hospital, Fukuyama, Japan.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|July 29, 2010
Summary
Protecting the heart during aortic valve replacement in patients with prior bypass surgery is complex. This case study shows successful myocardial protection using continuous hypothermic perfusion of a patent left internal thoracic artery graft and retrograde coronary sinus perfusion.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Myocardial Protection Strategies
Background:
- Aortic valve replacement (AVR) in patients with prior coronary artery bypass grafting (CABG) presents unique myocardial protection challenges.
- Maintaining the integrity of patent grafts, particularly the left internal thoracic artery (LITA), is crucial during re-operations.
Observation:
- A case of AVR was performed in a patient with a patent LITA graft from previous CABG.
- The LITA graft was intentionally not dissected to prevent injury.
- Systemic hypothermia was maintained at 28°C, and retrograde coronary sinus perfusion was employed after aortic clamping.
Findings:
- Myocardial protection was achieved through continuous systemic hypothermic perfusion of the patent LITA graft combined with intermittent retrograde coronary sinus perfusion during AVR.
- The patient was weaned from cardiopulmonary bypass without difficulty.
Implications:
- This approach demonstrates a viable strategy for myocardial protection in complex AVR cases with patent LITA grafts.
- Successful outcomes suggest that preserving graft integrity and utilizing combined perfusion techniques can be effective.
- Further research may explore optimizing these techniques for broader application in re-operative cardiac surgery.
