Hybrid approach for redo mitral valve surgery with safe intermittent catheter balloon occlusion of a patent arterial T-graft

摘要

Because of their excellent long-term patency, both internal thoracic arteries (ITAs) are commonly used for coronary artery bypass grafting (CABG) [1, 2]. However, redo surgery of the mitral valve (MV) after previous ITA revasculariza-tion performed with the T-graft technique (implantation of one ITA into the other and creation of multiple distal anastomoses for complete coronary revascu-larization) is particularly challenging, because of potential fatal graft injury and/ or the risk of suboptimal myocardial protection after cross-clamping of the aorta. The common approaches in such a situation are: (1) to dissect the T-graft carefully, clamp it externally, and apply cardio-plegia, or (2) to leave the graft open accepting cardioplegia washout and filling of the heart by backflow of the graft. In our report we describe a case of successful redo MV surgery for severe endocarditis with endovascular control and safe intermittent catheter balloon occlusion of a patent T-graft.