[Valve surgery in patients with prior coronary artery bypass grafting].

Valve surgery in patients with prior coronary artery bypass grafting (CABG) is challenging procedure. If the patent graft was injured during resternotomy or dissection of the graft, operative mortality and morbidity was significantly increased. To avoid the injury, left internal mammary artery( LIMA)should be passed through under the left lung and right internal mammary artery (RIMA) should be avoided if valve surgery is anticipated in the future. We invented "internal mammary artery (IMA)-non-touch procedure" which included systemic hyperkalemia and mild hypothermia during cardiopulmonary bypass without touching IMA. With this technique, cardiac arrest can be achieved without myocardial injury avoiding IMA injury. Available transcatheter aortic valve replacement (TAVR) is awaited in Japan. Patent graft is no longer a risk for TAVR, although long term results have not been obtained. Therefore, once TAVR becomes available, TAVR can be the standard therapy for aortic valve replacement( AVR) in patients with prior CABG.