Aortic valve replacement by ministernotomy in redo patients with previous left internal mammary artery patent grafts

Roberto Gaeta, Salvatore Lentini, Giuseppe Raffa, Carlo Pellegrini, Giuseppe Zattera, Mario Viganò

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Objective: Aortic valve surgery with a patent left internal mammary artery (LIMA) on the left anterior descending (LAD) coronary artery is challenging in terms of myocardial protection and graft injury. Minimally invasive techniques may require minimal dissection of adhesions and may eventually decrease the risk of injuries. Methods: Since 1997, more than 1000 ministernotomies have been performed by our surgical unit. Of these, 16 patients (14 males, 2 females, mean age: 68.7 years) had a patent LIMA graft on LAD. Fourteen underwent native aortic valve replacement, and in 2 a previously implanted prosthesis was replaced. A miniresternotomy was performed using either a "J" (15 patients) or a "reversed-T" method (1 patient). Results: Cardiopulmonary bypass (CPB) was achieved by either femoral vein (12 patients) or right atrium (4 patients); arterial inflow was achieved either by ascending aorta (12 patients) or by femoral artery (4 patients). Mean CPB time was 119.7 ± 38.1 minutes (range: 50-235). Mean cooling body temperature was 27.4°C. Antegrade cold crystalloid cardioplegia was delivered to all the patients. Mean aortic cross-clamp time was 72 ± 20 minutes (range: 45-125). No damage to LIMA occurred in any of the patients. No intra- or perioperative myocardial infarction (MI) occurred. Neither a conversion to full sternotomy nor a reoperation for bleeding was needed. Mean postoperative bleeding was 426 ± 474 ml (range: 120-1950). A blood transfusion was necessary in 7 patients. Mean postoperative ICU stay was 1.6 ± 1.1 days. Mean postoperative hospital stay was 7.5 ± 2.6 days. Postoperative course was totally uneventful in 10 patients (58.8%). Follow-up was complete for a total of 928 patient/months (range: 11-124), and there were four late deaths, two of which were related to cardiac problems. Nine of the 12 survivors are in NYHA CLASS I • II. Prosthesis-related morbidity did not occur either early or late during follow-up. Conclusions: This experience may represent the feasibility of an alternative surgical approach to a standard full-length median sternotomy in patients with previous coronary revascularization and with a patent LIMA on the LAD, requiring new surgery on the aortic valve.

Original languageEnglish
Pages (from-to)181-186
Number of pages6
JournalAnnals of Thoracic and Cardiovascular Surgery
Volume16
Issue number3
Publication statusPublished - Jun 2010

Fingerprint

Mammary Arteries
Aortic Valve
Transplants
Sternotomy
Cardiopulmonary Bypass
Prostheses and Implants
Hemorrhage
Induced Heart Arrest
Femoral Vein
Wounds and Injuries
Patient Rights
Femoral Artery
Heart Atria
Body Temperature
Reoperation
Blood Transfusion
Survivors
Aorta
Dissection
Length of Stay

Keywords

  • Aortic valve replacement
  • Minimally invasive
  • Reoperation

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Gastroenterology

Cite this

Aortic valve replacement by ministernotomy in redo patients with previous left internal mammary artery patent grafts. / Gaeta, Roberto; Lentini, Salvatore; Raffa, Giuseppe; Pellegrini, Carlo; Zattera, Giuseppe; Viganò, Mario.

In: Annals of Thoracic and Cardiovascular Surgery, Vol. 16, No. 3, 06.2010, p. 181-186.

Research output: Contribution to journalArticle

@article{7b292b4caf974bcaa4b8051cf4f0caa7,
title = "Aortic valve replacement by ministernotomy in redo patients with previous left internal mammary artery patent grafts",
abstract = "Objective: Aortic valve surgery with a patent left internal mammary artery (LIMA) on the left anterior descending (LAD) coronary artery is challenging in terms of myocardial protection and graft injury. Minimally invasive techniques may require minimal dissection of adhesions and may eventually decrease the risk of injuries. Methods: Since 1997, more than 1000 ministernotomies have been performed by our surgical unit. Of these, 16 patients (14 males, 2 females, mean age: 68.7 years) had a patent LIMA graft on LAD. Fourteen underwent native aortic valve replacement, and in 2 a previously implanted prosthesis was replaced. A miniresternotomy was performed using either a {"}J{"} (15 patients) or a {"}reversed-T{"} method (1 patient). Results: Cardiopulmonary bypass (CPB) was achieved by either femoral vein (12 patients) or right atrium (4 patients); arterial inflow was achieved either by ascending aorta (12 patients) or by femoral artery (4 patients). Mean CPB time was 119.7 ± 38.1 minutes (range: 50-235). Mean cooling body temperature was 27.4°C. Antegrade cold crystalloid cardioplegia was delivered to all the patients. Mean aortic cross-clamp time was 72 ± 20 minutes (range: 45-125). No damage to LIMA occurred in any of the patients. No intra- or perioperative myocardial infarction (MI) occurred. Neither a conversion to full sternotomy nor a reoperation for bleeding was needed. Mean postoperative bleeding was 426 ± 474 ml (range: 120-1950). A blood transfusion was necessary in 7 patients. Mean postoperative ICU stay was 1.6 ± 1.1 days. Mean postoperative hospital stay was 7.5 ± 2.6 days. Postoperative course was totally uneventful in 10 patients (58.8{\%}). Follow-up was complete for a total of 928 patient/months (range: 11-124), and there were four late deaths, two of which were related to cardiac problems. Nine of the 12 survivors are in NYHA CLASS I • II. Prosthesis-related morbidity did not occur either early or late during follow-up. Conclusions: This experience may represent the feasibility of an alternative surgical approach to a standard full-length median sternotomy in patients with previous coronary revascularization and with a patent LIMA on the LAD, requiring new surgery on the aortic valve.",
keywords = "Aortic valve replacement, Minimally invasive, Reoperation",
author = "Roberto Gaeta and Salvatore Lentini and Giuseppe Raffa and Carlo Pellegrini and Giuseppe Zattera and Mario Vigan{\`o}",
year = "2010",
month = "6",
language = "English",
volume = "16",
pages = "181--186",
journal = "Annals of Thoracic and Cardiovascular Surgery",
issn = "1341-1098",
publisher = "Japanese Association for Coronary Artery Surgery",
number = "3",

}

TY - JOUR

T1 - Aortic valve replacement by ministernotomy in redo patients with previous left internal mammary artery patent grafts

AU - Gaeta, Roberto

AU - Lentini, Salvatore

AU - Raffa, Giuseppe

AU - Pellegrini, Carlo

AU - Zattera, Giuseppe

AU - Viganò, Mario

PY - 2010/6

Y1 - 2010/6

N2 - Objective: Aortic valve surgery with a patent left internal mammary artery (LIMA) on the left anterior descending (LAD) coronary artery is challenging in terms of myocardial protection and graft injury. Minimally invasive techniques may require minimal dissection of adhesions and may eventually decrease the risk of injuries. Methods: Since 1997, more than 1000 ministernotomies have been performed by our surgical unit. Of these, 16 patients (14 males, 2 females, mean age: 68.7 years) had a patent LIMA graft on LAD. Fourteen underwent native aortic valve replacement, and in 2 a previously implanted prosthesis was replaced. A miniresternotomy was performed using either a "J" (15 patients) or a "reversed-T" method (1 patient). Results: Cardiopulmonary bypass (CPB) was achieved by either femoral vein (12 patients) or right atrium (4 patients); arterial inflow was achieved either by ascending aorta (12 patients) or by femoral artery (4 patients). Mean CPB time was 119.7 ± 38.1 minutes (range: 50-235). Mean cooling body temperature was 27.4°C. Antegrade cold crystalloid cardioplegia was delivered to all the patients. Mean aortic cross-clamp time was 72 ± 20 minutes (range: 45-125). No damage to LIMA occurred in any of the patients. No intra- or perioperative myocardial infarction (MI) occurred. Neither a conversion to full sternotomy nor a reoperation for bleeding was needed. Mean postoperative bleeding was 426 ± 474 ml (range: 120-1950). A blood transfusion was necessary in 7 patients. Mean postoperative ICU stay was 1.6 ± 1.1 days. Mean postoperative hospital stay was 7.5 ± 2.6 days. Postoperative course was totally uneventful in 10 patients (58.8%). Follow-up was complete for a total of 928 patient/months (range: 11-124), and there were four late deaths, two of which were related to cardiac problems. Nine of the 12 survivors are in NYHA CLASS I • II. Prosthesis-related morbidity did not occur either early or late during follow-up. Conclusions: This experience may represent the feasibility of an alternative surgical approach to a standard full-length median sternotomy in patients with previous coronary revascularization and with a patent LIMA on the LAD, requiring new surgery on the aortic valve.

AB - Objective: Aortic valve surgery with a patent left internal mammary artery (LIMA) on the left anterior descending (LAD) coronary artery is challenging in terms of myocardial protection and graft injury. Minimally invasive techniques may require minimal dissection of adhesions and may eventually decrease the risk of injuries. Methods: Since 1997, more than 1000 ministernotomies have been performed by our surgical unit. Of these, 16 patients (14 males, 2 females, mean age: 68.7 years) had a patent LIMA graft on LAD. Fourteen underwent native aortic valve replacement, and in 2 a previously implanted prosthesis was replaced. A miniresternotomy was performed using either a "J" (15 patients) or a "reversed-T" method (1 patient). Results: Cardiopulmonary bypass (CPB) was achieved by either femoral vein (12 patients) or right atrium (4 patients); arterial inflow was achieved either by ascending aorta (12 patients) or by femoral artery (4 patients). Mean CPB time was 119.7 ± 38.1 minutes (range: 50-235). Mean cooling body temperature was 27.4°C. Antegrade cold crystalloid cardioplegia was delivered to all the patients. Mean aortic cross-clamp time was 72 ± 20 minutes (range: 45-125). No damage to LIMA occurred in any of the patients. No intra- or perioperative myocardial infarction (MI) occurred. Neither a conversion to full sternotomy nor a reoperation for bleeding was needed. Mean postoperative bleeding was 426 ± 474 ml (range: 120-1950). A blood transfusion was necessary in 7 patients. Mean postoperative ICU stay was 1.6 ± 1.1 days. Mean postoperative hospital stay was 7.5 ± 2.6 days. Postoperative course was totally uneventful in 10 patients (58.8%). Follow-up was complete for a total of 928 patient/months (range: 11-124), and there were four late deaths, two of which were related to cardiac problems. Nine of the 12 survivors are in NYHA CLASS I • II. Prosthesis-related morbidity did not occur either early or late during follow-up. Conclusions: This experience may represent the feasibility of an alternative surgical approach to a standard full-length median sternotomy in patients with previous coronary revascularization and with a patent LIMA on the LAD, requiring new surgery on the aortic valve.

KW - Aortic valve replacement

KW - Minimally invasive

KW - Reoperation

UR - http://www.scopus.com/inward/record.url?scp=77955116416&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77955116416&partnerID=8YFLogxK

M3 - Article

C2 - 20930679

AN - SCOPUS:77955116416

VL - 16

SP - 181

EP - 186

JO - Annals of Thoracic and Cardiovascular Surgery

JF - Annals of Thoracic and Cardiovascular Surgery

SN - 1341-1098

IS - 3

ER -