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Ann Thorac Surg 2004;78:782-785
© 2004 The Society of Thoracic Surgeons

Original article: cardiovascular

Redo-aortic valve replacement after previous bilateral internal thoracic artery bypass grafting

Hitoshi Hirose, MDa,*, Inderjit S. Gill, MDa, Bruce W. Lytle, MDa

a Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA

Accepted for publication February 10, 2004.

* Address reprint requests to Dr Gill, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, ME90, 3rd Floor, Hamann Bldg, 2500 Metro Health Dr, Cleveland, OH 44109-1998, USA
gillis{at}ccf.org

BACKGROUND: Aortic valve replacement (AVR) after coronary artery bypass using bilateral internal thoracic arteries (ITAs) is a challenge. Management of these patent grafts and myocardial protection are important issues. Moreover the risk and outcome of these complex operations have not been clearly defined.

METHODS: Eighteen consecutive patients (all male) who exhibited previous bilateral ITA grafts underwent subsequent AVR surgery from 1990–2001 at the Cleveland Clinic Foundation. Their medical records were retrospectively analyzed.

RESULTS: At the time of reoperation, the mean age of the patients was 67 ± 6.4 years and 33 out of 36 (92%) ITAs were patent. The interval between previous coronary bypass and aortic valve surgery was 10.3 ± 5.3 years. All patients underwent redo-median sternotomy with aortic cannulation in 12 patients (67%) and femoral or axillary artery cannulation in 6 patients (33%). The patent ITAs were clamped during aortic cross-clamping in 15 patients. In 3 patients the ITAs were not dissected. These 3 patients underwent deep hypothermic arrest for myocardial protection. Concomitant coronary revascularization was performed in 8 patients (44%). There were no hospital deaths. One stroke occurred but there were no other major complications. Average intubation time was 23.1 ± 27.1 hours, intensive care unit stay was 2.3 ± 3.1 days, and postoperative hospital stay was 10.3 ± 7.6 days.

CONCLUSIONS: Reoperative aortic valve surgery in the patients with patent bilateral ITA grafts can be performed safely.




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