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Eur J Cardiothorac Surg 2009;35:1114-1115. doi:10.1016/j.ejcts.2009.03.002
Copyright © 2009, European Association for Cardio-thoracic Surgery. Published by Elsevier. All rights reserved.
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Letters to the Editor

Reply to Lentini et al.

Redo-sternotomy and myocardial protection in patients with patent LIMA-grafts

Nawid Khaladj*, Malakh Shrestha, Axel Haverich, Christian Hagl

Division of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany

Received 7 March 2009; accepted 10 March 2009.

* Corresponding author. Tel.: +49 511 532 6581; fax: +49 511 532 5404. (Email: Khaladj.Nawid{at}mh-hannover.de).

Key Words: Redo sternotomy • Aortic valve replacement • Myocardial protection • LIMA graft

We thank Dr Lentini and co-workers for their comments and interest in our work [1].

Our retrospective study was performed in patients who were considered to have a high surgical risk for aortic valve replacement (AVR) due to the patent (LIMA) graft after previous coronary artery bypass grafting (CABG) [2]. Besides the question of the value of scoring systems, the manuscript has been focused on the technical aspects of our approach [3].

With great interest we have read the remarks of our colleagues concerning their technique of a partial upper J sternotomy in those cases. We agree that this may be an elegant option in patients with patent bypass grafts [1]. Since the partial sternotomy has become increasingly popular in the last few years, surgeons are now more familiar with this approach, even in redos.

The other important issue concerning myocardial protection has also been addressed by Dr Lentini. In this context it may be beneficial to avoid cross-clamping of the LIMA, which may cause clamping injury. To avoid damage to the heart this approach can be combined with hypothermia.

In general, there are different surgical ways to deal with this challenging subset of patients. In this context we have to be aware that conventional surgery can be performed with excellent results. Therefore, catheter-based techniques have to be compared with the ‘old fashioned’ conventional way of surgery. This does not mean that new approaches should not be pushed further.

Again, we congratulate Lentini and co-workers for their good results and valuable discussion [1].

References

  1. Lentini S, Perotta S, Gaeta R. Surgical approach for isolated aortic valve replacement with patent coronary grafts. Eur J Cardiothorac Surg 2009;35:1114.[Free Full Text]
  2. Vahanian A, Alfieri OR, Al-Attar N, Antunes MJ, Bax J, Cormier B, Cribier A, De Jaegere P, Fournial G, Kappetein AP, Kovac J, Ludgate S, Maisano F, Moat N, Mohr FW, Nataf P, Pierard L, Pomar JL, Schofer J, Tornos P, Tuzcu M, van Hout B, von Segesser LK, Walther T. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg 2008;34:1-8.[Abstract/Free Full Text]
  3. Khaladj N, Shrestha M, Peterss S, Kutschka I, Strueber M, Hoy L, Haverich A, Hagl C. Isolated surgical aortic valve replacement after previous coronary artery bypass grafting with patent grafts: is this old-fashioned technique obsolete?. Eur J Cardiothorac Surg 2008;35:260-264.[CrossRef][Medline]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Nawid Khaladj
Malakh Shrestha
Axel Haverich
Christian Hagl
Right arrow Permission Requests
Google Scholar
Right arrow Articles by Khaladj, N.
Right arrow Articles by Hagl, C.
PubMed
Right arrow Articles by Khaladj, N.
Right arrow Articles by Hagl, C.
Related Collections
Right arrow Minimally invasive surgery
Right arrow Myocardial protection
Right arrow Valve disease

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