title: Aortic valve replacement after previous coronary artery bypass grafting: experience with a simplified approach.
abstract: OBJECTIVE
  Aortic valve replacement (AVR) after previous coronary artery bypass grafting (CABG), particularly in a patent left internal thoracic artery (ITA), is a challenge. Avoidance of injuring the patent graft and ensuring myocardial protection are important issues in the management of these patients. The aim of this study was to evaluate a simplified surgical approach to these reoperations.
  
  
  METHODS
  Between January 2003 and June 2005, 19 of 287 AVRs performed at our institution were in a patient subset (mean age 70 years, range: 62-82) who received AVR after previous CABG surgery. The aortic valve gradients were between 50 and 107 mm Hg. Our operation strategy followed the KIS-principle (keep it simple): both femoral vessels were cannulated using the Seldinger technique. Only the area around the ascending aorta and the right atrium was dissected to permit x-clamping, aortotomy, and catheterization for retrograde cardioplegia and a left ventricular vent. The anterior aspect of the heart and the left side, where the ITA was embedded and patent, were left untouched and not clamped.
  
  
  RESULTS
  The mean interval between the first and second operation was 6.5 years. Fourteen patients received biological prostheses. Four patients received an additional surgery at the time of AVR. The mean operating time was 267 min; the mean AoX-clamp time was 63 min. One patient died because of severe heart failure. In all others the postoperative course was uneventful.
  
  
  CONCLUSIONS
  We believe that the indication for AVR in patients scheduled for CABG should be re-evaluated. In those in which Redo-surgery for new or increased valve stenosis is indicated, a simple and safe surgical option is presented.
authors.affiliation: Department of Cardiothoracic Surgery, Bergmannsheil Bochum Ruhr-University Hospital Bochum, Germany. delawer.reber@ruhr-uni-bochum.de
authors.forename: D
authors.initials: D
authors.lastname: Reber
authors.forename: M
authors.initials: M
authors.lastname: Fritz
authors.forename: W
authors.initials: W
authors.lastname: Bojara
authors.forename: P
authors.initials: P
authors.lastname: Marks
authors.forename: A
authors.initials: A
authors.lastname: Laczkovics
authors.forename: P
authors.initials: P
authors.lastname: Tossios
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome