Redo mitral surgery after coronary artery bypass grafts under
hyperkalemic hypothermia using thoracotomy and axillary artery
cannulation in a patient with functional bilateral internal thoracic
arteries and atheromatous aorta
Abstract
We report a case of redo mitral and tricuspid valve repair via right
thoracotomy under hypothermia and systemic potassium administration with
axillary artery cannulation in a patient after coronary artery bypass
grafting (CABG) with patent bilateral internal thoracic artery (ITA)
grafts crossing over the sternum. Redo mitral valve surgery is
challenging through re-sternotomy as previous CABG with patent ITA poses
a risk of injury due to dense adhesion. Herein, dangerous dissection
around the aorta and functional ITA grafts was avoided by performing the
procedure under systemic hypothermia via thoracotomy. Furthermore,
considering the presence of atheroma in the aorta, the axillary artery
was used as a perfusion route to prevent stroke events. Performing
axillary artery cannulation and right thoracotomy under hypothermic
cardiac arrest with systemic hyperkalemia without clamping the patent
bilateral ITAs and aorta allowed us to execute redo mitral valve surgery
after CABG without major postoperative cardiac or cerebral
complications.