Aortic valve replacement, coronary artery bypass grafting and carotid endarterectomy under continuous coronary perfusion, cardiopulmonary bypass and mechanical ventilation in a patient with heart failure and reduced left ventricular ejection fraction

We present surgical treatment of a patient with low left ventricular ejection fraction (22%), decompensated aortic valve disease, coronary artery disease and carotid artery stenosis. The patient underwent surgery under parallel cardiopulmonary bypass and mechanical ventilation. A 57-year-old man was diagnosed with aortic stenosis and massive calcification, severe dilatation of cardiac chambers, lesions of coronary arteries and stenosis 90% of the right internal carotid artery. Severe circulatory decompensation and reduced ejection fraction to 22% were noted. EuroSCORE II was 21.65%. Simultaneous surgery included right-sided carotid endarterectomy at the first stage, aortic valve replacement under cardiopulmonary bypass, continuous coronary perfusion, pulmonary artery perfusion and mechanical ventilation at the second stage and coronary artery bypass grafting of the left anterior descending and right coronary arteries under normothermic cardiopulmonary bypass without cardioplegia at the third stage. The patient was extubated 17 hours later. Postoperative period was complicated by multiple organ failure. A single course of hemocorrection was performed. The patient was discharged in 20 days after surgery with clinical improvement (NYHA class II). This case demonstrates the possibility of simultaneous surgery in such patients. However, decision making on such interventions should be based on all risk factors in each patient.