title: Minimal dissection and continuous retrograde cardioplegia for aortic valve replacement in patients with a patent left internal mammary artery bypass graft.
abstract: OBJECTIVE
  Aortic valve replacement (AVR) in patients with previous coronary artery bypass grafting (CABG) and a patent pedicled internal mammary artery (IMA) is often complicated by a need to dissect and clamp the IMA to achieve optimal myocardial protection. Eliminating this need may simplify and facilitate surgery; hence, a new surgical technique for use in these patients is described.
  
  
  METHODS
  Five patients with previous CABG and functioning IMA who required AVR between January 1998 and October 2002 were studied. In all patients, the IMA was neither dissected nor clamped. Myocardial protection comprised an initial bolus of antegrade cardioplegia, followed by continuous retrograde infusion of tepid non-diluted oxygenated blood, supplemented with cardioplegic drugs to maintain cardiac arrest. The systemic and myocardial temperature was 30-32 degrees C.
  
  
  RESULTS
  All patients underwent surgery as planned, and there was no operative mortality or myocardial infarction. One patient sustained a minor stroke. None of the IMA was injured.
  
  
  CONCLUSIONS
  In patients requiring AVR, it is both possible and reasonable to leave the IMA undissected and unclamped. Limited experience suggests that this new technique provides adequate myocardial protection, while keeping surgery both simple and safe.
authors.affiliation: Department of Cardiac Surgery, Rambam Medical Center and the Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Bar-El
authors.forename: Arkady
authors.initials: A
authors.lastname: Kophit
authors.forename: Oved
authors.initials: O
authors.lastname: Cohen
authors.forename: Victor
authors.initials: V
authors.lastname: Kertzman
authors.forename: Simcha
authors.initials: S
authors.lastname: Milo
mesh_terms: D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D004210:Dissection; D004452:Echocardiography; D005260:Female; D006324:Heart Arrest, Induced; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007362:Intensive Care Units; D007557:Israel; D007902:Length of Stay; D008297:Male; D008323:Mammary Arteries / Q000000981:diagnostic imaging / Q000637:transplantation*; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology; D011188:Potassium / Q000097:blood; D011474:Prosthesis Design; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D011188:Potassium