Aortic valve replacement via a right parasternal approach in a patient with a history of coronary artery bypass surgery and pericardiectomy: a case report.

Background: The number of patients who require aortic valve replacement after coronary artery bypass grafting continues to increase. Re-operative cardiovascular surgery after coronary artery bypass grafting has various risk factors related to median re-sternotomy. It is particularly essential to avoid damage to the living graft. We successfully performed aortic valve replacement via right parasternal thoracotomy in a patient who had undergone coronary artery bypass grafting.

Methods: An 80-year-old man who had undergone coronary artery bypass grafting was referred to our hospital for syncope caused by severe aortic valve stenosis. He also had a history of pericardiotomy for constrictive pericarditis. His left internal thoracic artery bypass graft was patent. Aortic valve replacement was performed through a small right parasternal thoracotomy during cardiac arrest following cardiopulmonary bypass under moderate hypothermia and hyperkalemia by intermittent selective antegrade cardioplegia. His postoperative course was uneventful.

Conclusions: Aortic valve replacement via right parasternal thoracotomy with moderate hypothermia and hyperkalemia was safe and effective for avoidance of re-sternotomy-related complications.