Aortic valve replacement following previous coronary surgery.

Aortic valve replacement following previous coronary surgery is associated with high risk. Major intraoperative problems include those associated with reentry, damage to the left internal mammary artery and myocardial protection. These factors influence operative results and eventual outcome to a large extent. The available evidence largely consists of retrospective series and case reports, with their own institutional bias, and it has been difficult to make specific recommendations on the basis of this evidence. However the article reviews the various surgical options available to manage this difficult subset of patients and discusses their pros and cons.