A Case of Aortic Valve Replacement Performed on a Beating Heart

(Department of Cardiovascular Surgery, Yotsuba Circulation Clinic, Matsuyama, Japan)

Yuichiro Yokoyama Harumitsu Satoh Masato Imura
A 75-year-old man was admitted to our hospital because of severe aortic stenosis associated with fainting spells. He had undergone coronary artery bypass grafting at the age of 66, and had progressive aortic stenosis for 9 years. Ultrasound showed left ventricular hypertrophy and a calcified aortic valve. The aortic valve area was 0.34cm² and the mean pressure gradient was 56mmHg. Multi detector-row computed tomography showed patent bypass grafts(LITA-LAD, SVG-OM-PL, and SVG-RCA)and a persistent left superior vena cava(PLSVC). Coronary angiography revealed total occlusion of all the 3 native coronary arteries, therefore, antegrade cardioplegic perfusion was impossible. Retrograde perfusion was also impossible because of the PLSVC. We had to clamp the LITA and infuse the cardioplegic solution through the SVG graft to obtain cardioplegic arrest. Performing aortic valve replacement(AVR)on a beating heart facilitates the operation, because it negates the need to clamp the patent bypass graft and the PLSVC. We exposed a minimal area of the operating field, ascending aorta, and right atrium. Cardiopulmonary bypass was established by cannulating the ascending aorta and right atrium. The right pulmonary vein was cannulated for left ventricular venting. The ascending aorta was cross clamped on the proximal side of the SVG. AVR was thus performed using the standard approach on the beating heart with coronary perfusion through the bypassed graft. The postoperative course was uneventful, and the patient was discharged 15 days postoperatively. Redo surgery is more complex than primary surgery and is associated with higher mortality and morbidity. Beating heart surgery is one of the optional methods in such a complex case.
  Jpn. J. Cardiovasc. Surg. 40:251-254(2011)

Keywords:beating heart surgery, aortic valve replacement, coronary artery bypass grafting