Reoperative Cardiac Surgery in Jehovah's Witness Patients with Patent Internal Thoracic Artery Grafts: How Far Can We Push the Envelope?
AbstractReoperative cardiac surgery in Jehovah's Witness (JW) patients with patent internal mammary arteries is a formidable surgical challenge. We have successfully performed 2 such cases using creative approaches. The first patient, a morbidly obese woman, presented with an acute coronary syndrome 4 years after off-pump coronary artery bypass grafting (CABG) with a hemoglobin of 10 gm/dL. She was stabilized with stenting of the culprit vessel; erythropoietin therapy was performed to increase her hemoglobin, and surgery was performed electively. The internal thoracic artery (ITA) was dissected and clamped, and intermittent cardioplegia was used for myocardial protection. The second patient needed aortic valve replacement 3 years after a previous CABG using an ITA. Limited dissection was used at redo operation without exposing the ITA. Aortic valve replacement was performed under cold fibrillatory arrest with an open ITA. Successful reoperative cardiac surgery in JW patients requires preoperative preparation using a multidisciplinary team approach and flexible operative planning.
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