title: Redo aortic valve surgery with endovascular control of the internal thoracic artery graft.
abstract: OBJECTIVE
  Redo aortic valve surgery (AVS) in patients with patent pedicled internal thoracic artery (ITA) grafts remains a challenging procedure because of the possibility of injury to the grafts and difficulties in optimal myocardial protection. This procedure is associated with a significant mortality and morbidity. Different approaches to myocardial protection and ITA graft dissection and control have been described. An intraoperative technique is proposed that provides endovascular control of the ITA graft, using an angioplasty balloon positioned during cross-clamping.
  
  
  METHODS
  Ten consecutive patients with previous coronary artery bypass grafting (CABG) and a patent pedicled ITA who underwent AVS were studied. The ITA grafts were occluded by using an angioplasty balloon during cross-clamping, but were not dissected and controlled.
  
  
  RESULTS
  Endovascular control of the ITA graft was feasible in all cases, without complication. Two intraoperative complications (both graft injuries) were observed; one injury of an ITA graft, and one injury of a radial artery graft. There was no postoperative mortality. One myocardial infarct was related to the injury of a radial graft. The clamped ITA grafts were studied at two months after the procedure in five patients, and showed all grafts to be patent. At a mean follow up of 13 months, all patients were alive without any coronary events.
  
  
  CONCLUSIONS
  The endovascular control of a patent ITA graft during redo AVS is a safe and simple technique that reduces the risk of ITA graft injury and also improves myocardial protection.
authors.affiliation: Department of Cardiovascular Surgery, Hôpital Nord, Saint-Etienne, France. jf.fuzellier@orange.fr
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Fuzellier
authors.forename: Damien
authors.initials: D
authors.lastname: Metz
authors.forename: Yves-Assad
authors.initials: YA
authors.lastname: Saade
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Favre
authors.forename: Xavier
authors.initials: X
authors.lastname: Barral
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D021721:Balloon Occlusion / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D003250:Constriction; D057510:Endovascular Procedures / Q000009:adverse effects; D005260:Female; D005602:France; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis; D008297:Male; D008323:Mammary Arteries / Q000503:physiopathology / Q000637:transplantation*; D008875:Middle Aged; D012086:Reoperation; D016896:Treatment Outcome; D014654:Vascular Patency