Aortic operation after previous coronary artery bypass grafting: management of patent grafts for myocardial protection.
OBJECTIVE
Aortic surgery for progressive aortic valve disease or aortic aneurysm after previous coronary artery bypass grafting (CABG) is a challenging procedure. We report the outcome of aortic reoperation after previous CABG and evaluate our management of patent grafts and our methods for obtaining myocardial protection.


METHODS
From February 2001 to July 2003, 6 patients with progressive aortic valve disease and aneurysm of the thoracic aorta were operated on. The group comprised 3 men and 3 women with a mean age of 67.6 years. There were 4 patients with an aneurysm of the aortic arch, 1 with chronic ascending aortic dissection, and 1 with progressive aortic valve stenosis. The interval between previous CABG and aortic surgery was 74.0 +/- 44.2 months. All reoperations were performed via median resternotomy. Myocardial protection was obtained by hypothermic perfusion of patent in-situ arterial grafts following cold-blood cardioplegia administration via the aortic root under aortic cross clamping.


RESULTS
The operative procedure was aortic arch replacement in 4 patients, ascending aortic replacement with double CABG in 1, and aortic valve replacement in 1. All patients survived the reoperation. Postoperative maximum creatine kinase-MB was 49.2 +/- 29.8 and no new Q-waves occurred in the electrocardiogram nor were any new wall motion abnormalities recognized on echocardiography. There were no late deaths during a follow-up of 30.7 months.


CONCLUSIONS
Reoperative aortic procedures after CABG can be performed safely with myocardial protection via hypothermic perfusion of a patent in-situ arterial graft.
Nakajima
Masato
M
Department of Cardiovascular Surgery, Yamanashi Central Hospital, Yamanashi, Japan.
Tsuchiya
Koji
K
Fukuda
Shoji
S
Morimoto
Hironobu
H
Mitsumori
Yoshitaka
Y
Kato
Kaori
K
D000368:Aged; D000784:Aortic Dissection / Q000201:enzymology / Q000503:physiopathology / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000201:enzymology / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000201:enzymology / Q000503:physiopathology / Q000601:surgery*; D009202:Cardiomyopathies / Q000201:enzymology / Q000503:physiopathology / Q000517:prevention & control*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D001026:Coronary Artery Bypass; D052279:Creatine Kinase, MB Form / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D013318:Stroke Volume; D016896:Treatment Outcome; D014654:Vascular Patency; D016277:Ventricular Function, Left
D052279:Creatine Kinase, MB Form