Introduction
The operative risk of aortic valve replacement (AVR) after coronary
artery bypass grafting (CABG) is known to be high because graft may be
injured by median sternotomy, leading to serious myocardial ischemia and
resultant poor prognosis.1 Moreover, in some cases,
trans-catheter aortic valve replacement (TAVR) after CABG can not be
selected for various reasons, and surgical AVR must be
performed.2 In such situations, myocardial protection
during cardiac surgery is an important point of discussion, and some
unique methods have been reported to avoid graft
damage.3 We experienced a case of AVR through right
lateral mini-thoracotomy after CABG with the bilateral internal thoracic
artery (ITA) grafts. As the grafts were patent and native coronary
arteries were totally occluded, systemic hyperkalemia and deep
hypothermia were utilized to induce cardiac arrest and maintain adequate
myocardial protection without touching the bilateral ITA grafts. Herein
is reported the methods and cautions in this strategy. We have obtained
the consent of the patient for publication.