Aortic valve replacement after previous coronary artery bypass grafting: a case report.

We experienced a case of aortic valve replacement after previous coronary artery bypass grafting with patent bypass grafts. Based on the retrosternal anatomy assessed by preoperative angiography and thoracic computed tomography, aortic valve replacement was performed through a median resternotomy. After careful dissection of the right side of the heart and the ascending aorta, cardiopulmonary bypass was established with cannulation of the ascending aorta and bicaval venous cannulation. The patent bypass grafts were dissected only as required for clamping and were clamped during cardiac arrest. After aortic valve replacement, the patient was uneventfully weaned from cardiopulmonary bypass and had a good postoperative recovery. It is important that surgeons have a meticulous strategy for reducing the risks associated with operating on patients with patent bypass grafts. We report on the surgical management of patients undergoing aortic valve replacement after previous coronary artery bypass grafting, including careful planning during the first operation.