Objective
Aortic surgery for progressive aortic valve disease or aortic aneurysm after previous coronary artery bypass grafting (CABG) is a challenging procedure. We report the outcome of aortic reoperation after previous CABG and evaluate our management of patent grafts and our methods for obtaining myocardial protection.Methods: From February 2001 to July 2003, 6 patients with progressive aortic valve disease and aneurysm of the thoracic aorta were operated on. The group comprised 3 men and 3 women with a mean age of 67.6 years. There were 4 patients with an aneurysm of the aortic arch, 1 with chronic ascending aortic dissection, and 1 with progressive aortic valve stenosis. The interval between previous CABG and aortic surgery was 74.0±44.2 months. All reoperations were performed via median resternotomy. Myocardial protection was obtained by hypothermic perfusion of patentin-situ arterial grafts following cold-blood cardioplegia administration via the aortic root under aortic cross clamping.Results: The operative procedure was aortic arch replacement in 4 patients, ascending aortic replacement with double CABG in 1, and aortic valve replacement in 1. All patients survived the reoperation. Postoperative maximum creatine kinase-MB was 49.2±29.8 and no new Q-waves occurred in the electrocardiogram nor were any new wall motion abnormalities recognized on echocardiography. There were no late deaths during a follow-up of 30.7 months.Conclusion: Reoperative aortic procedures after CABG can be performed safely with myocardial protection via hypothermie perfusion of a patentin-situ arterial graft. (Jpn J Thorac Cardiovasc Surg 2006; 54:155-159)
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Odell JA, Mullany CJ, Schaff HV, Orszulak TA, Daly RC, Morris JJ. Aortic valve replacement after previous coronary artery bypass grafting. Ann Thorac Surg 1996; 62: 1424–30.
Byrne JG, Karavas AN, Filsoufi F, Mihaljevic T, Aklog L, Adams DH, et al. Aortic valve surgery after previous coronary artery bypass grafting with functional internal mammary artery grafts. Ann Thorac Surg 2002; 73: 779–84.
Hirose H, Gill IS, Lytle BW. Redo-aortic valve replacement after previous bilateral internal thoracic artery bypass grafting. Ann Thorac Surg 2004; 78: 782–5.
Sundt TM 3rd, Murphy SF, Barzilai B, Schuessler RB, Mendeloff EN, Huddleston CB, et al. Previous coronary artery bypass grafting is not a risk factor for aortic valve replacement. Ann Thorac Surg 1997; 64: 651–8.
Gillinov AM, Casselman FP, Lytle BW, Blackstone EH, Parsons EM, Loop FD, et al. Injury to a patent left internal thoracic artery graft at coronary reoperation. Ann Thorac Surg 1999; 67: 382–6.
Aviram G, Sharony R, Kramer A, Nesher N, Loberman D, Ben-Gal Y, et al. Modification of surgical planning based on cardiac multidetector computed tomography in reoperative heart surgery. Ann Thoracic Surg 2005; 79: 589–95.
Byrne JG, Aranki SF, Couper GS, Adams DH, Allred EN, Cohn LH. Reoperative aortic valve replacement: Partial upper hemisternotomy versus conventional full sternotomy. J Thorac Cardiovasc Surg 1999; 118: 991–7.
Ueda T, Kawata T, Sakaguchi H, Tabayashi N, Abe T, Hirose T, et al. Aortic valve replacement in a patient with a patent internal thoracic artery graft. Ann Thoracic Surg 2004; 77: 718–20.
Sutherland FW, West M, Pathi V. Aortic valve replacement with continuously perfused beating heart in patients with patent bypass conduits. Eur J Cardiothorac Surg 2004; 26: 834–6.
Borger MA, Rao V, Weisel RD, Floh AA, Cohen G, Feindel CM, et al. Reoperative coronary bypass surgery: Effect of patent grafts and retrograde cardioplegia. J Thorac Cardiovasc Surg 2001; 121: 83–90.
Kuralay E, Cingoz F, Gunay C, Oz BS, Kucukarslan N, Yildirim V, et al. Supraclavicular control of patent internal thoracic artery graft flow during aortic valve replacement. Ann Thorac Surg 2003; 75: 1422–8.
Fuzellier JF, Metz D, Poncet A, Saade YA. Endovascular control of patent internal thoracic artery graft in aortic valve surgery. Ann Thorac Surg 2005; 79:el7–8.
Nakajima M, Tsuchiya K, Naito Y, Hibino N, Inoue H. How to establish myocardial protection during aortic arch operation in patients with patent left internal thoracic artery graft: Careful dissection or no touch technique? J Thorac Cardiovasc Surg 2002; 124: 1254–5.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Nakajima, M., Tsuchiya, K., Fukuda, S. et al. Aortic operation after previous coronary artery bypass grafting. Jpn J Thorac Caridovasc Surg 54, 155–159 (2006). https://doi.org/10.1007/BF02662470
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF02662470