A simple technique for aortic valve replacement in patients with a patent left internal mammary artery bypass graft

Aortic valve replacement in patients with a patent left internal mammary artery graft is often a challenge because of the difficulties with dissection of the left internal mammary artery and optimum myocardial protection. We describe a simple technique of aortic valve replacement with a beating heart and continuous coronary perfusion for this difficult group of patients.