Mini re-sternotomy for aortic valve replacement in patients with patent coronary bypass grafts.
As the population ages, an increasing number of patients with patent coronary grafts will require subsequent aortic valve replacement. Major operative problems include those associated with re-entry and, in particular, damage of the patent grafts. Between January 2007 and October 2008, 10 patients who had previous coronary bypass surgery underwent aortic valve replacement through upper j-shaped mini re-sternotomy. In all patients the previous grafts were patent. The operation was performed with normothermic cardiopulmonary bypass without dissection and temporary closure of the arterial and venous coronary bypass grafts. The mean age was 73.2+/-13.6 years. The patients had a mean of 2.8+/-0.6 bypass grafts. There were no intraoperative complications due to redo ministernotomy and at no time conversion to full re-sternotomy was necessary. No damage to the previous grafts was reported and the incidence of perioperative myocardial infarction was 0%. One patient required a pacemaker implantation for atrio-ventricular block. The in-hospital mortality was 0%. Aortic valve replacement in previous coronary bypass grafting can be performed safely with a mini re-sternotomy. This approach avoids extensive dissection, decreasing the risk of injuries to heart chambers and previous patent coronary grafts with low morbidity and mortality.
Department of Cardiovascular Surgery, Villa Maria Cecilia Hospital, Cotignola, Lugo (RA), Italy. dellamore76@libero.it
Andrea
A
Dell'Amore
Mauro
M
Del Giglio
Simone
S
Calvi
Marco
M
Pagliaro
Corrado
C
Fedeli
Diego
D
Magnano
Alberto
A
Tripodi
Mauro
M
Lamarra
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D006324:Heart Arrest, Induced; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D018570:Risk Assessment; D013249:Sternum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency