[Aortic valve replacement using the "no-touch technique" for a patent internal thoracic artery].

Myocardial protection in the setting of patent grafts is often challenging in patients who have undergone prior myocardial revascularization and require a 2nd operation for aortic valve replacement (AVR). We report a case of AVR in a patient who had undergone prior coronary bypass grafting. The patent left internal thoracic artery (LITA) graft was not dissected to avoid graft injury. Systemic hypothermia was maintained at 28 degrees C. After the ascending aorta was clamped, retrograde coronary sinus perfusion was performed. During AVR, myocardial protection was obtained by continuous systemic hypothermic perfusion of the patent LITA graft and intermittent retrograde coronary sinus perfusion. Weaning from cardiopulmonary bypass was not difficult. The patient's postoperative course was satisfactory.