A 63-year-old male, with a history of coronary artery bypass grafting
using bilateral internal thoracic artery grafts, underwent surgical
aortic valve replacement. Avoiding the graft injury, we selected the
right anterior mini-thoracotomy approach under cardiac arrest with
systemic hyperkalemia with remaining bilateral internal thoracic artery
grafts open. Deep hypothermia was induced to obtain more reliable
myocardial protection. We believe this strategy can be considered as a
therapeutic option in patients requiring aortic valve replacement but
unsuitable for transcatheter aortic valve replacement.