title: [Mitral valve replacement after previous coronary artery bypass grafting with functioning left internal thoracic artery graft: effectiveness of the method using a direct vision retrosternal approach; report of a case].
abstract: Performing a redo-sternotomy when a mammary artery graft is patent can be rather difficult. We previously reported a redo-sternotomy technique involving direct visualization with a retrosternal dissection (DR) method using a Kent's retractor. The DR method in detail is as follows: 1) A midline skin incision is extended to the abdomen about 5 cm. 2) The bilateral costal arches are divided from the rectal muscle. 3). A pair of retractors is placed under the costal arch. 4) A stainless steel wire is applied to the previous sternal wire at the center of the sternum. 5) The retractor and sternal wire are lifted up using the Kent's retractor to widen the retrosternal space. 6) The sternum and sub-sternal tissue are carefully divided using an electronic scalpel or metal retractor with an entirely sternal length. 7) Routine sternotomy is performed using a Stryker. Herein, we report a patient who had undergone cardiac surgery, coronary artery bypass grafting (CABG), using a left internal mammary artery and mitral annuloplasty 2 years previously, and then developed mitral regurgitation caused by infectious endocarditis. He successfully underwent redo-sternotomy and mitral valve replacement using the DR method. In a patient with a patent internal mammary artery, the DR method greatly reduces the risk of graft injury.
authors.affiliation: Department of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan.
authors.forename: Junichi
authors.initials: J
authors.lastname: Sakata
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Saito
authors.forename: Akira
authors.initials: A
authors.lastname: Fujii
authors.forename: Masaru
authors.initials: M
authors.lastname: Tsukamoto
authors.forename: Osamu
authors.initials: O
authors.lastname: Date
authors.forename: Hideo
authors.initials: H
authors.lastname: Yokoyama
authors.forename: Tomio
authors.initials: T
authors.lastname: Abe
authors.forename: Atsunobu
authors.initials: A
authors.lastname: Nakase
authors.forename: Katsumi
authors.initials: K
authors.lastname: Ohori
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D004696:Endocarditis / Q000150:complications; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012086:Reoperation; D056346:Sternotomy / Q000379:methods*