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A simplified surgical approach for aortic valve replacement after previous coronary artery bypass grafting

Department of Thoracic and Cardiovascular Surgery, Pierre et Marie Curie University, Pitié Salpêtrière Hospital, Institut du Coeur, Paris, France

Received 21 November 2008; received in revised form 5 April 2009; accepted 7 April 2009.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, Pitié Salpêtrière Hospital, 47-83 boulevard de l’hôspital, 75651 Paris Cedex 13, France. Tel.: +33 680684382; fax: +33 142165629. (Email: stephaneaubert{at}yahoo.fr).

Aortic valve replacement (AVR) in patients who have undergone previous coronary artery bypass grafting (CABG) is a challenging redo surgery. We undertook this study to evaluate the early and late outcomes of patients operated upon using a simplified surgical approach. Between January 2001 and December 2005, 2238 patients underwent AVR in our institution. We reviewed retrospectively the 57 patients who had AVR following previous CABG. All patients underwent cardiopulmonary bypass with a mild-to-moderate systemic hypothermia (mean temperature: 29.7 ± 2.5 °C). Patent internal thoracic artery (IMA) grafts were never dissected, controlled or clamped. A mechanical or biological prosthesis was implanted considering the patient's age. The mean cardiopulmonary bypass (CPB) time was 93 ± 29 min (median: 80 min, range: 43–244 min) and the mean aortic cross-clamp (AoX) time was 63 ± 18 min (median: 59 min, range: 31–125 min). The early mortality was 10.5% and the late mortality was 9.8% (mean follow-up time: 38 months). The survival was 81% at 5 years and the freedom from major cardiac events was 77%. In conclusion, from our experience, the operating quickness and a simplified approach (‘open IMA technique’, anterograde cardioplegia, mild-to-moderate hypothermia and minimal dissection of the mediastinal structures) represent two fundamental choices to perform this type of surgery easily, safely and with optimal results.

Key Words: Valve disease • Myocardial protection