A Surgical Approach for Aortic Valve Replacement in a Patient with a Functional Right Internal Thoracic Artery Graft Located Close to the Posterior of the Sternum

(Department of Cardiovascular Surgery, Miyazaki Medical Association Hospital, Miyazaki, Japan)

Kouji Furukawa Takahiro Hayase Mitsuhiro Yano
A 78-year-old woman who had undergone triple coronary bypass grafting with the right internal thoracic artery(RITA)to the left anterior descending artery 8 years previously was referred to our hospital because of heart failure due to progressive aortic valve stenosis. Coronary angiography showed that all of the coronary grafts were patent, and multidetector-row computed tomography demonstrated the functional RITA graft located close to the posterior of the sternum at the level of the second costal cartilage. To prevent injury of the RITA graft, we initially performed an inverted-L-shaped partial sternotomy extended to the right second intercostal space. After institution of peripheral cardiopulmonary bypass, we performed careful removal of adhesions along the posterior of the sternum under decompressed conditions and accomplished resternotomy safely. The patent internal thoracic artery grafts were never dissected and the patient was cooled to a rectal temperature of 22℃. After aortic crossclamping, myocardial arrest was obtained with systemic hyperkalemia by instilling 40 mEq of potassium chloride into the cardiopulmonary bypass circuit and we successfully performed aortic valve replacement. This method is an alternative approach for re-do cardiac surgery after previous bypass grafting in patients with a functional RITA graft located close to the posterior of the sternum.
  Jpn. J. Cardiovasc. Surg. 41:231-234(2012)

Keywords:re-do cardiac surgery, aortic valve replacement, functional right internal thoracic artery graft, resternotomy, partial sternotomy