Ewha Med J.  2014 Mar;37(1):64-67. 10.12771/emj.2014.37.1.64.

Aortic Valve Replacement after Previous Coronary Artery Bypass Grafting with Patent Internal Mammary Artery

• Jin MN
• Kim SW
• Kim YJ
• Kim HJ
• Lee JH
• Hong MK
• Chang BC

• KMID: 2171278
• DOI: http://doi.org/10.12771/emj.2014.37.1.64

Abstract

With the aging population, more patients who have undergone previous coronary artery bypass grafting (CABG) are surviving long enough to require subsequent aortic valve replacement (AVR). Conventional redo AVR after prior CABG involves resternotomy, dissection and clamping of the patent bypass graft vessel. Favorable results have been reported for AVR following previous CABG; however, the problems of this procedure includes that injury to the patent bypass grafts can result in catastrophic complications. Increasing patient age and comorbidities may increase operative mortality, less invasive percutaneous aortic valve intervention has advanced. However, because there are no sufficient data comparing transcatheter aortic valve intervention with surgical AVR, currently, the surgical approach should still be consider as the standard of treatment for AVR following previous CABG. We report a patient in whom successful conventional AVR was underwent after previous CABG with patent left internal mammary artery.

Keyword

Heart Valve Prosthesis Implantation; Coronary artery bypass; Aortic valve stenosis; Mammary arteries

MeSH Terms

Aging
Aortic Valve Stenosis
Aortic Valve*
Comorbidity
Constriction
Coronary Artery Bypass*
Coronary Vessels*
Heart Valve Prosthesis Implantation
Humans
Mammary Arteries*
Mortality
Transplants

Figure

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  Fig. 1 Pre- and post-operative 2-dementional Doppler transthoracic echocardiograpsy. Severe aortic stenosis with aortic valve effective orifice area (EOA) of 0.6 cm2 and transvalvular peak pressure gradient (PPG) of 56.4 mmHg is shown on preoperative 2-dementional Doppler transthoracic echocardiography (A). Decreased transvalvular PPG of 17.2 mmHg and increased aortic valve EOA of 1.45 cm2 are observed on the following postoperative transthoracic echocardiography (B).

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  Fig. 2 Preoperative angiography showing good patency of bypass grafts. The left internal mammary artery (LIMA) is anastomosed to the distal left anterior descending artery (LAD). Harvested saphenous vein (SV) is inserted to LIMA and connected to 2nd obtuse marginal branch and to right posterior descending branch (PD).

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  Fig. 3 Preoperative 3-dimentional multidetector computed tomography (MDCT) angiography showing the left internal mammary artery (LIMA) and the saphenous vein grafts (A). One-year follow-up MDCT angiography reveals the patency of the LIMA and the saphenous vein (SV) grafts (B). LAD, left anterior descending artery.

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