Markus Thalmann1, Franz Veit1, Gottfried H. Sodeck2, Michael Gorlitzer1, Martin Grabenwoeger1.
1Hospital Hietzing, Vienna, Austria, 2Univesity Hospital, Vienna, Austria.
OBJECTIVE:
Aortic valve replacement following coronary artery bypass grafting is a well known problem in cardiac surgery. Several techniques have been discussed and used in such cases like continuous application of cardioplegia, deep hypothermic circulatory arrest as well as beating heart technique with retrograde warm blood perfusion by the coronary sinus.
METHODS: We report our experience in a case of severe aortic valvular stenosis nine years after all arterial coronary artery bypass grafting with perfect patent grafts (LIMA-LAD, RIMA-t-graft-OM, gastroepiploic artery-PDA). The arterial canula was connected to an 8mm Dacron prostheses which had been anastomosed to the right subclavian artery, the venous canula had been inserted by the right groin. After sternotomy and preparation of the right aspect of the heart a vent was inserted by the right upper pulmonary vein. After cross-clamping and aortotomy a balloon-blocker was inserted into the left coronary ostium to prevent steel-phenomenon.
RESULTS: The patient was on sinus rhythm throughout the procedure. A 21mm Carpentier Edwards magna bioprosthesis was implanted without any difficulties. Weaning from cardiopulmonary-bypass was uneventfully. Postoperative blood-samplings didn’t show relevant elevation of cardiac enzymes. The patient was extubated the next day and discharged from hospital after TTE -control which showed a perfect postoperative result.
CONCLUSIONS: Beating heart aortic valve replacement is an excellent alternative technique in redo-patients after previous CABG-surgery with patent grafts. As the variability of the morphology in these patients can be broad spreaded, patients have to be analysed individually before operation. Different techniques for redo-operations as well as the indication for valve replacement in primary CABG procedures with concomittant mild to moderate aortic valve stenosis will be discussed.
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