Selection of patients over 75 years old for open combined surgery and endpoints of assessment of outcomes of aortic valve replacement with coronary arteries bypass grafting: reflections on a clinical case

2018 ◽  
Vol 15 (4) ◽  
pp. 277-285
Author(s):  
T.G. Nikitina ◽  
R.M. Muratov ◽  
A.A. Fadeev ◽  
N.Z. Tsitlidze ◽  
L.A. Glushko
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Arteries ◽  
Clinical Case ◽  
Bypass Grafting ◽  
Combined Surgery ◽  
Selection Of Patients ◽  
Selection Of

scholarly journals Anomalous aortic origin of right and circumflex coronary arteries - procedural risks during combined aortic valve replacement and coronary artery bypass grafting

2018 ◽  
Vol 146 (7-8) ◽  
pp. 440-444
Author(s):  
Mladen Kocica ◽  
Milica Karadzic ◽  
Milos Grujic ◽  
Dragan Cvetkovic ◽  
Ljiljana Soskic
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Arteries ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Coronary Artery Anomalies ◽  
The Right ◽  
Congenital Coronary Artery Anomalies

Introduction. Anomalous aortic origin of the right and the circumflex coronary arteries presents extremely rare and potentially dangerous combination in patients scheduled for combined coronary bypass grafting and aortic valve replacement surgery. We report this illustrative case to emphasize the importance of meticulous diagnostic setup enabling the surgeon to anticipate and avoid numerous possible pitfalls. Case outline. A 74-year-old woman, with anterior-wall myocardial infarction and aortic valve stenosis, underwent successful combined coronary artery bypass grafting and aortic valve replacement. Preoperative coronary angiography revealed unusually high take-off of the right main coronary trunk and anomalous origin and course of the circumflex coronary artery. Anatomy of both anomalous coronary arteries in the light of underlying surgical pathology necessitated a meticulous preparation and caution during successive phases of surgical treatment. Conclusion. Estimating potential procedural risk should be standard practice for each patient with known congenital coronary artery anomalies, regardless of the natural risk imposed by a particular anomaly. Preoperative evaluation of coronary circulation, with high surgical awareness and knowledge of different congenital coronary artery anomalies, should be a standard approach in cardiac surgical practice. This would add a predictive value for an actual procedural risk in cases of previously unrecognized anomalies.

scholarly journals Video assisted, transaortic removal of left ventricular thrombus during concurrent cardiac surgery: a case report

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Aditya Eranki ◽  
Claudia Villanueva ◽  
Nicholas Collins ◽  
Peng Seah
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Coronary Artery Bypass ◽  
Valve Replacement ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Bypass Grafting ◽  
Ventricular Thrombus

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.

scholarly journals Clinical case: aortic valve replacement with aortic root reconstruction and coronary artery bypass grafting in 73-yo obese female patient

2018 ◽  
Vol 9 (1) ◽  
pp. 71-75
Author(s):  
D. V. Borisov ◽  
A. S. Zotov ◽  
S. A. Vachev ◽  
A. V. Troitskiy ◽  
R. I. Khabazov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Female Patient ◽  
Valve Replacement ◽  
Aortic Root ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Obese Female

Aortic valve replacement is the second most common cardiac surgery procedure. Prosthesis-patient size mismatch can increase the incidence of adverse events postoperatively, it also leads to increased left ventricular load. Some studies describe the higher mortality in this group of patients. It is also proved that patients with severe aortic stenosis usually have impaired platelet aggregation and low von Willebrand factor causing bleeding disorders. We report a case of successful aortic valve replacement and aortic root enlargement (Nicks technique) combined with coronary artery bypass grafting (left internal mammary artery to the left anterior descending artery) and left atrial appendage resection in 73-y.o. obese female patient. Postoperative course was uneventful.

scholarly journals Obstruction of 2 Coronary Arteries from Different Causes Immediately after Transapical Transcatheter Aortic Valve Replacement

2020 ◽  
Vol 47 (1) ◽  
pp. 30-34
Author(s):  
Umihiko Kaneko ◽  
Ryuji Koshima ◽  
Hirosato Doi ◽  
Tsutomu Fujita
Keyword(s):  
Coronary Artery ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Arteries ◽  
Transcatheter Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Rare Complication ◽  
Left Main ◽  
Transcatheter Aortic Valve

Coronary obstruction, a rare complication of transcatheter aortic valve replacement, can be fatal. Few data exist on this phenomenon, and, to date, authors have reported only single coronary lesions. We present a case in which 2 coronary arteries obstructed immediately after transapical transcatheter aortic valve replacement. The patient was an 81-year-old woman with symptomatic severe aortic stenosis who underwent transapical transcatheter aortic valve replacement. Immediately after an Edwards Sapien XT valve was deployed, she experienced sudden cardiogenic shock resulting from obstruction of the left main coronary artery ostium and the distal left anterior descending coronary artery. The left main obstruction was caused by direct compression from a large calcified mass and the valve frame. The left anterior descending coronary artery obstruction was caused by ambient myocardial tightening and external compression around the apical sutures. Revascularization was achieved through coronary stent placement and suture removal, respectively. Our patient's case highlights the risk for coronary obstructions after transapical transcatheter aortic valve replacement, and we discuss how they can be managed.

Combined coronary artery bypass grafting and aortic valve replacement

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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