Reoperative aortic valve replacement through upper hemisternotomy.

Reoperative aortic valve replacement (AVR) has become increasingly common (1). In patients with previous coronary artery bypass grafting (CABG), minimally invasive reoperative AVR is the preferred approach since it allows the performance of no-touch technique for left internal mammary artery (LIMA) and minimal dissection around the vein grafts (2,3). Here, we present an 83-year-old man with symptomatic severe aortic stenosis and a positive history of coronary artery disease (CAD), hypertension, dyslipidemia, chronic renal disease, peripheral vascular disease and carotid stenosis. He has had a CABG and carotid endarterectomy and was found to be ineligible for transcatheter aortic valve replacement (TAVR) due to severe iliofemoral calcification. Coronary grafts were proven patent by angiography, while left ventricular function and wall motion were proven normal by echocardiography. The patient was scheduled for a minimally invasive isolated AVR reoperation through upper hemisternotomy.