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Aortic valve replacement by ministernotomy in redo patients with previous left internal mammary artery patent grafts.
Ann Thorac Cardiovasc Surg. 2010 Jun; 16(3):181-6.AT

Abstract

OBJECTIVE

Aortic valve surgery with a patent left internal mammary artery (LIMA) on the left anterior descending (LAD) coronary artery is challenging in terms of myocardial protection and graft injury. Minimally invasive techniques may require minimal dissection of adhesions and may eventually decrease the risk of injuries.

METHODS

Since 1997, more than 1000 ministernotomies have been performed by our surgical unit. Of these, 16 patients (14 males, 2 females, mean age: 68.7 years) had a patent LIMA graft on LAD. Fourteen underwent native aortic valve replacement, and in 2 a previously implanted prosthesis was replaced. A miniresternotomy was performed using either a "J" (15 patients) or a "reversed-T" method (1 patient).

RESULTS

Cardiopulmonary bypass (CPB) was achieved by either femoral vein (12 patients) or right atrium (4 patients); arterial inflow was achieved either by ascending aorta (12 patients) or by femoral artery (4 patients). Mean CPB time was 119.7 ± 38.1 minutes (range: 50-235). Mean cooling body temperature was 27.4 °C. Antegrade cold crystalloid cardioplegia was delivered to all the patients. Mean aortic cross-clamp time was 72 ± 20 minutes (range: 45-125). No damage to LIMA occurred in any of the patients. No intra- or perioperative myocardial infarction (MI) occurred. Neither a conversion to full sternotomy nor a reoperation for bleeding was needed. Mean postoperative bleeding was 426 ± 474 ml (range: 120-1950). A blood transfusion was necessary in 7 patients. Mean postoperative ICU stay was 1.6 ± 1.1 days. Mean postoperative hospital stay was 7.5 ± 2.6 days. Postoperative course was totally uneventful in 10 patients (58.8%). Follow-up was complete for a total of 928 patient/months (range: 11-124), and there were four late deaths, two of which were related to cardiac problems. Nine of the 12 survivors are in NYHA CLASS I . II. Prosthesis-related morbidity did not occur either early or late during follow-up.

CONCLUSIONS

This experience may represent the feasibility of an alternative surgical approach to a standard full-length median sternotomy in patients with previous coronary revascularization and with a patent LIMA on the LAD, requiring new surgery on the aortic valve.

Authors+Show Affiliations

University of Pavia, Pavia, Italy.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20930679

Citation

Gaeta, Roberto, et al. "Aortic Valve Replacement By Ministernotomy in Redo Patients With Previous Left Internal Mammary Artery Patent Grafts." Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, vol. 16, no. 3, 2010, pp. 181-6.
Gaeta R, Lentini S, Raffa G, et al. Aortic valve replacement by ministernotomy in redo patients with previous left internal mammary artery patent grafts. Ann Thorac Cardiovasc Surg. 2010;16(3):181-6.
Gaeta, R., Lentini, S., Raffa, G., Pellegrini, C., Zattera, G., & Viganò, M. (2010). Aortic valve replacement by ministernotomy in redo patients with previous left internal mammary artery patent grafts. Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 16(3), 181-6.
Gaeta R, et al. Aortic Valve Replacement By Ministernotomy in Redo Patients With Previous Left Internal Mammary Artery Patent Grafts. Ann Thorac Cardiovasc Surg. 2010;16(3):181-6. PubMed PMID: 20930679.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aortic valve replacement by ministernotomy in redo patients with previous left internal mammary artery patent grafts. AU - Gaeta,Roberto, AU - Lentini,Salvatore, AU - Raffa,Giuseppe, AU - Pellegrini,Carlo, AU - Zattera,Giuseppe, AU - Viganò,Mario, PY - 2009/01/07/received PY - 2009/03/17/accepted PY - 2010/10/9/entrez PY - 2010/10/12/pubmed PY - 2011/4/20/medline SP - 181 EP - 6 JF - Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia JO - Ann Thorac Cardiovasc Surg VL - 16 IS - 3 N2 - OBJECTIVE: Aortic valve surgery with a patent left internal mammary artery (LIMA) on the left anterior descending (LAD) coronary artery is challenging in terms of myocardial protection and graft injury. Minimally invasive techniques may require minimal dissection of adhesions and may eventually decrease the risk of injuries. METHODS: Since 1997, more than 1000 ministernotomies have been performed by our surgical unit. Of these, 16 patients (14 males, 2 females, mean age: 68.7 years) had a patent LIMA graft on LAD. Fourteen underwent native aortic valve replacement, and in 2 a previously implanted prosthesis was replaced. A miniresternotomy was performed using either a "J" (15 patients) or a "reversed-T" method (1 patient). RESULTS: Cardiopulmonary bypass (CPB) was achieved by either femoral vein (12 patients) or right atrium (4 patients); arterial inflow was achieved either by ascending aorta (12 patients) or by femoral artery (4 patients). Mean CPB time was 119.7 ± 38.1 minutes (range: 50-235). Mean cooling body temperature was 27.4 °C. Antegrade cold crystalloid cardioplegia was delivered to all the patients. Mean aortic cross-clamp time was 72 ± 20 minutes (range: 45-125). No damage to LIMA occurred in any of the patients. No intra- or perioperative myocardial infarction (MI) occurred. Neither a conversion to full sternotomy nor a reoperation for bleeding was needed. Mean postoperative bleeding was 426 ± 474 ml (range: 120-1950). A blood transfusion was necessary in 7 patients. Mean postoperative ICU stay was 1.6 ± 1.1 days. Mean postoperative hospital stay was 7.5 ± 2.6 days. Postoperative course was totally uneventful in 10 patients (58.8%). Follow-up was complete for a total of 928 patient/months (range: 11-124), and there were four late deaths, two of which were related to cardiac problems. Nine of the 12 survivors are in NYHA CLASS I . II. Prosthesis-related morbidity did not occur either early or late during follow-up. CONCLUSIONS: This experience may represent the feasibility of an alternative surgical approach to a standard full-length median sternotomy in patients with previous coronary revascularization and with a patent LIMA on the LAD, requiring new surgery on the aortic valve. SN - 2186-1005 UR - https://www.unboundmedicine.com/medline/citation/20930679/Aortic_valve_replacement_by_ministernotomy_in_redo_patients_with_previous_left_internal_mammary_artery_patent_grafts_ L2 - https://medlineplus.gov/coronaryarterydisease.html DB - PRIME DP - Unbound Medicine ER -