Non-manipulation of Patent LIMA in the Setting of Reoperative Aortic Valve Replacement in Patients with Previous Coronary Artery Bypass

Abstract Introduction Left ventricular (LV) thrombus is a complication of acute myocardial infarction and is associated with systemic thromboembolism. We describe a trans-aortic endoscopic approach to the removal of an LV thrombus in a patient undergoing concurrent coronary artery bypass grafting and aortic valve replacement. Case presentation A 47 year old male presented following an embolic middle cerebral artery stroke and underwent transthoracic echocardiography demonstrating a mobile LV thrombus. Additional investigation revealed a moderately stenosed bicispid aortic valve, two vessel coronary artery disease and ischemic cardiomyopathy. The patient underwent early surgery to reduce the risk of further embolic episodes. A trans-aortic approach was utilized with videoscopy and single shafted instrumentation to aide in removal of the thrombus. The patient then underwent aortic valve replacement and coronary artery bypass grafting. Conclusion We report an alternative technique for the removal of a left ventricular thrombus in a patient undergoing concurrent coronary and aortic valve surgery. The transaortic video-assisted approach provided excellent visualisation of the apex and near complete removal of the thrombus without damaging the surrounding trabeculae. The main benefit of this technique is sparing of LV tissue, thereby preserving left ventricular function.

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Should coronary artery bypass graft surgery patients with mild or moderate aortic stenosis undergo concomitant aortic valve replacement?

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2004.06.031 ◽

2004 ◽

Vol 44 (6) ◽

pp. 1241-1247 ◽

Cited By ~ 64

Author(s):

William T. Smith ◽

T. Bruce Ferguson ◽

Thomas Ryan ◽

Carolyn K. Landolfo ◽

Eric D. Peterson

Keyword(s):

Coronary Artery ◽

Aortic Valve ◽

Aortic Stenosis ◽

Aortic Valve Replacement ◽

Coronary Artery Bypass Graft ◽

Coronary Artery Bypass ◽

Valve Replacement ◽

Artery Bypass ◽

Bypass Graft ◽

Artery Bypass Graft

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Combined coronary artery bypass grafting and aortic valve replacement

State of the Art Surgical Coronary Revascularization ◽

10.1093/med/9780198758785.003.0077 ◽

2021 ◽

pp. 451-454

Author(s):

Christopher Lau ◽

Leonard N. Girardi

Keyword(s):

Coronary Artery ◽

Coronary Artery Bypass Grafting ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Coronary Artery Bypass ◽

Valve Replacement ◽

Artery Bypass ◽

Bypass Grafting ◽

Artery Bypass Grafting ◽

Cardiac Procedures

Aortic valve replacement and/or coronary artery bypass grafting (CABG) have become the most common cardiac procedures as the population ages and life expectancy increases. In isolation, both CABG and aortic valve replacement are performed with excellent outcomes throughout the world with operative mortalities of 1–2%. Both procedures have seen significant advances in recent years. The combination of an aortic valve procedure and CABG adds increased complexity and risk, which must be accounted for during operative planning in order to mitigate as much of the increased risk as possible. Improvements in postoperative care, myocardial protection, and operative techniques for combined CABG and aortic valve replacement have resulted in an operative mortality of 0.8–6.4% in recent series.

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Chylopericardium following aortic valve replacement and coronary artery bypass surgery: a case report and discussion

American Journal of Critical Care ◽

10.4037/ajcc1994.3.4.313 ◽

1994 ◽

Vol 3 (4) ◽

pp. 313-315

Author(s):

M Schactman ◽

C Scott ◽

DR Glibbery-Fiesel ◽

M Murello ◽

P Kerr

Keyword(s):

Cardiac Surgery ◽

Case Report ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Coronary Artery Bypass ◽

Valve Replacement ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass

The incidence of chylopericardium after cardiac surgery is unusual, but there are documented cases. Those caring for these patients need to be aware of the symptoms and management of chylopericardium because, if left untreated, it may cause catastrophic consequences.

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