A Surgical Case of Fourth Reoperation Using a Unique Technique of Cardioplegia

Abstract

The method of cardioplegic myocardial protection is often controversial for re-cardiotomy after a coronary artery bypass grafting (CABG). A 69-year-old woman with a history of three previous surgeries consisting of closed mitral commissurotomy (CMC), dual valve replacement (DVR), and CABG underwent mitral valve replacement (MVR) and CABG for perivalvular leakage (PVL). As a result, the bilateral coronary ostium and the bypass graft to the right coronary artery (RCA) were totally occluded. The left internal thoracic artery (LITA) graft to the left anterior descending (LAD) coronary artery was the only inflow to the left coronary artery system and the right coronary artery system developed collateral inflow. Cardioplegia was carried out by performing a temporary anastomosis graft on the saphenous vein graft (SVG) in the left anterior descending coronary artery and a new bypass graft in the RCA was used for the administration of cardioplegic solution with no complications. There are various strategies for cardioplegic myocardial protection. The best method should be selected depending on the patient characteristics and condition.