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

Affiliations
  • 1Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea. mkhong61@yuhs.ac
  • 2Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.

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

  • 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).

  • 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).

  • 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.


Reference

1. 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; 62:1424–1430.
2. Byrne JG, Karavas AN, Filsoufi F, Mihaljevic T, Aklog L, Adams DH, et al. Aortic valve surgery after previous coronary artery bypass grafting with functioning internal mammary artery grafts. Ann Thorac Surg. 2002; 73:779–784.
3. Lytle BW, McElroy D, McCarthy P, Loop FD, Taylor PC, Goormastic M, et al. Influence of arterial coronary bypass grafts on the mortality in coronary reoperations. J Thorac Cardiovasc Surg. 1994; 107:675–682.
4. Fighali SF, Avendano A, Elayda MA, Lee VV, Hernandez C, Siero V, et al. Early and late mortality of patients undergoing aortic valve replacement after previous coronary artery bypass graft surgery. Circulation. 1995; 92:II163–II168.
5. Park CB, Suri RM, Burkhart HM, Greason KL, Dearani JA, Schaff HV, et al. What is the optimal myocardial preservation strategy at re-operation for aortic valve replacement in the presence of a patent internal thoracic artery? Eur J Cardiothorac Surg. 2011; 39:861–865.
6. Suzuki S, Nakamura K, Takagi K, Kashikie H, Akaiwa K. Aortic valve replacement after previous coronary artery bypass grafting: a case report. Kurume Med J. 2013; 60:29–32.
7. Savitt MA, Singh T, Agrawal S, Choudhary A, Chaugle H, Ahmed A. A simple technique for aortic valve replacement in patients with a patent left internal mammary artery bypass graft. Ann Thorac Surg. 2002; 74:1269–1270.
8. Kamdar AR, Meadows TA, Roselli EE, Gorodeski EZ, Curtin RJ, Sabik JF, et al. Multidetector computed tomographic angiography in planning of reoperative cardiothoracic surgery. Ann Thorac Surg. 2008; 85:1239–1245.
9. Collart F, Feier H, Kerbaul F, Mouly-Bandini A, Riberi A, Mesana TG, et al. Valvular surgery in octogenarians: operative risks factors, evaluation of Euroscore and long term results. Eur J Cardiothorac Surg. 2005; 27:276–280.
10. Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010; 363:1597–1607.
11. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011; 364:2187–2198.
12. Ducrocq G, Al-Attar N, Himbert D, Messika-Zeitoun D, Iung B, Descoutures F, et al. Early and mid-term outcomes in patients undergoing transcatheter aortic valve implantation after previous coronary artery bypass grafting. Eur J Cardiothorac Surg. 2012; 41:499–504.
13. Vohra HA, Pousios D, Whistance RN, Haw MP, Barlow CW, Ohri SK, et al. Aortic valve replacement in patients with previous coronary artery bypass grafting: 10-year experience. Eur J Cardiothorac Surg. 2012; 41:e1–e6.
14. Khaladj N, Shrestha M, Peterss S, Kutschka I, Strueber M, Hoy L, et al. Isolated surgical aortic valve replacement after previous coronary artery bypass grafting with patent grafts: is this old-fashioned technique obsolete? Eur J Cardiothorac Surg. 2009; 35:260–264.
Full Text Links
  • EMJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2023 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr