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Ann Thorac Surg 2006;81:756-757
© 2006 The Society of Thoracic Surgeons

How to do it

Valve Replacement After T-Grafting: "Beating Heart Surgery"

Hendrick B. Barner, MD a , b , * , Thoralf M. Sundt, III, MD a , b , Cliff K. Choong, FRACS a , b

a Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
b Christian Hospital Northeast, St. Louis, Missouri

Accepted for publication November 22, 2004.

* Address correspondence to Dr Barner, 6125 Clayton Ave, Suite 430, St. Louis, MO 63139 (Email: hendrick.barner{at}tenethealth.com).

Patent internal thoracic and radial artery T-graft will adequately perfuse the heart during reoperation. Five of 1,023 patients with prior T-grafting had aortic (3) or mitral valve redo operations in which the heart was allowed to beat (after an initial dose of cardioplegia) during the operation without clamping the patent T-graft. Rapid resumption of cardiac function after one dose of cardioplegia and no intraoperative or postoperative evidence of myocardial infarction indicated adequacy of perfusion without apparent myocardial injury. This approach avoids injury to the T-graft from dissection and clamping, saves time, and simplifies the operation.






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