Introduction
With the aging of the population and improvement in survival rates, the
incidence of re-operative cardiac surgery is increasing. Re-operative
aortic valve replacement (AVR) with a patent internal thoracic artery
(ITA) previously anastomosed to the left anterior descending (LAD) is
challenging. Adequate myocardial protection is required while
cross-clamping the aorta to dissect and clamp the ITA and prevent
cardioplegia washout. However, several fatal complications, such as ITA
graft injury, catastrophic bleeding, and myocardial damage, can occur.
Conventional re-operative cardiac surgery with patent ITA anastomosed to
the coronary artery involves re-sternotomy, adequate tissue detachment,
and ITA clamping during aortic cross-clamping. Herein, we report a case
of re-operative AVR in a patient with a patent left ITA (LITA) flow to
LAD after coronary artery bypass grafting (CABG).