Mitral Valve Replacement in a Patient with Porcelain Aorta after Previous Myocardial Revascularization

Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality.Mitral valve (MV) reoperations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation.In this article we describe technique to manage systemic hyperkalemia in 68-year-old man who underwent bioprosthetic mitral valve replacement, already undergone coronary artery bypass grafting 13 years, come in our clinic to aggravated dyspnea caused by severe stenosis of the mitral valve.Because cross-clamping would have a high risk of stroke owing to severe calcification of the ascending aorta systemic hyperkalemia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing potential lesions due to demanding clamp placing.