Short-term graft patency of sequential and Y-graft in open heart surgery with transit time flow measurement.

AIM: In this prospective study, we aimed to compare flow characteristics and the short term patency of sequential and y-grafts by intraoperative transit time flow measurement. METHODS: Sixty patients were selected from 1374 isolated coronary bypass operations. Group 1 (N.=36) consisted of sequential grafted, Group 2 (N.=24) consisted of y-grafted patients. Intraoperative graft flow measurement was done with a transit time flow meter at stable hemodynamic conditions. We follow up the groups at the 30th day of the operation. RESULTS: The mean flows at measurement set up were 43.2±19.7 mL/min in Group 1 and 43.6±21.7 mL/min in Group 2. After distal graft clamp removal the same values were 63.4±20.9 mL/min in Group 1 and 67.3±35.3 ml/mins in Group 2. At the 30th day of the operation no patients died, and none of them had an acute myocardial infarction. CONCLUSION: The percent of flow increase in sequential graft group was higher but the difference of the percent of flow increase between groups was not statistically significant.

Mitral valve replacement with beating heart technique via right thoracotomy in a patient with previous Bentall operation.

Traditionally, reoperations for mitral valve replacement are carried out under cardioplegic arrest with cross-clamping of the ascending aorta via a median sternotomy. In this case, the mitral valve replacement operation was performed with an on-pump beating heart technique without cross-clamping the aorta and via a right thoracotomy because of diffuse adhesions around the ascending aortic tube graft. A 44-year-old male patient had undergone a Bentall operation via a median sternotomy for annulo-aortic ectasia 3 years ago. He was admitted to the hospital complaining of palpitation and dyspnea. Transthoracic echocardiography revealed 4th degree mitral insufficiency. Mitral valve replacement was carried out through a right thoracotomy using an on-pump beating heart technique without cross clamping the aorta. In conclusion, mitral valve replacement with an on-pump beating heart technique via a right thoracotomy offers a safe approach when excessive dissection is required to place a cross-clamp to the ascending aorta.