eComment: Aortic valve replacement in patients with patent coronary grafts: how to do it?

Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery. Aortic valve surgery after previous coronary artery bypass grafting with functioning internal mammary artery grafts. Do you need to clamp a patent left internal thoracic artery left anterior descending graft in reoperative cardiac surgery? Ann Thorac Surg 2009;87:742–747. w9x Sutherland FW, West M, Pathi V. Aortic valve replacement with continuously perfused beating heart in patients with patent bypass conduits. Haverich A, Hagl C. Isolated surgical aortic valve replacement after previous coronary artery bypass grafting with patent grafts: is this old-fashioned technique obsolete? Eur We read with great interest the article of Dell'Amore et al. w1x. In our opinion the authors deserve praise for their excellent results with a very difficult subset of patients. The authors demonstrated that a minimally invasive approach can be safely performed also in patients with patent coronary artery bypass grafts who require aortic valve replacement. Of particular interest is the fact that with this approach, the limited surgical dissection and the avoidance of grafts manipulation may significantly reduce bleeding and the incidence of injuries to coronary grafts. We have three questions for the authors: 1. We have recently reported an extremely low need of blood transfusion in patients with patent bypass grafts who underwent re-operative mitral surgery through a right minithoracotomy w2x. Did the authors find similar data on this aspect in their series? 2. In our center, isolated aortic valve replacement is routinely performed through a ministernotomy extending up to the second intercostal space or through a right minithoracotomy in the same intercostal space. In order to reduce the surgical dissection and the congestion of the working field, we use peripheral venous cannulation via the right femoral vein. Do the authors think that peripheral venous cannulation could be a good solution also for their approach? 3. Could the authors provide information about how they insert chest drains at the end of the procedure? re-sternotomy for aortic valve replacement in patients with patent coronary bypass grafts. Minimally invasive mitral valve surgery through right thoracotomy in patients with patent coronary artery bypass grafts. Surgical management of aortic valve disease in patients who already underwent bypass grafting is a matter of debate. In the paper of Dell'Amore and colleagues w1x, 10 patients with patent grafts underwent aortic valve replacement through a j-shaped ministernotomy in the 3rd or 4th intercos-tal space over a period of almost …