190-I * REVERSE U AORTOTOMY (KIRALI INCISION) FOR AORTIC VALVE REPLACEMENT AFTER PREVIOUS VALVE-SPARING ISOLATED AORTIC ROOT REPLACEMENT AND CORONARY ARTERY BYPASS GRAFTING

Abstract

Objectives: The presence of patent vein grafts on the proximal aorta may give technical difficulties during exposure for aortic valve replacement (AVR) after previous coronary artery bypass (CABG) operations. A reverse U-shaped aortotomy allows excellent exposure of the aortic valve and antegrade cardioplegic administration without mobilizing the vein grafts. Using this approach, the site of proximal anastomosis was kept apart from the operative field while enhancing operative view. Methods: A 65-year-old man was admitted to our clinic for severe aortic regurgitation. He underwent valve-sparing aortic root replacement with singlevessel coronary bypass surgery (aorta to right coronary artery anastomosis with saphenous vein graft) in our clinic two years ago. His control angiography revealed that distal and proximal anastomoses were patent, with severe aortic regurgitation. He underwent an echocardiographic examination and severe aortic valve dysfunction with 4 degree insufficiency was observed. He was taken for reoperation for aortic valve replacement. Results: This technique allows protection of the venous graft located on the synthetic aortic graft, as in our case. Additionally, it provides perfect exposure, and results in further protection of the venous graft. It decreases the risk of cholesterol embolism, which occurs as a result of mobilization of cholesterol remnants within the venous graft, because there is no need for venous graft manipulation during this technique. The technique facilitates the application of cardioplegia through the coronary ostia and proximal venous graft. Conclusions: Reverse U aortotomy (Kirali incision) prevents unnecessary and risky manipulations of proximal venous anastomoses, and can be used securely during AVR surgery after previous CABG surgery.