Key result
Open aortic valve replacement with cardiopulmonary bypass prior to re-sternotomy was successfully performed with an uneventful postoperative course in a high-risk patient with extra-anatomic bypasses.
Case Report (n=1)
Open aortic valve replacement can be successfully performed in high-risk patients with prior complex extra-anatomic aortic bypasses using careful cannulation strategies.
Supports feasibility of open AVR after extra-anatomic bypass in select cases; hypothesis-generating and should not yet change practice.
The patient was 62-year-old male who successfully underwent an anatomic repair of aortic coarctation at the age of 15 and an extra-anatomic ascending aorta- to-descending aorta bypass (graft size 20 mm) and an extra-anatomic ascending aorta to the left subclavian artery bypass (graft size 10 mm) at the age of 49. As he grew older he started presenting clinical symptoms of aortic stenosis. The echocardiogram showed a bicuspid aortic valve with severe stenosis and a mean gradient of 65 mm Hg. Despite the high surgical risk, we decided to perform an open valve replacement with installing the CPB prior to re-sternotomy with a simultaneous cannulation of the axillary and femoral arteries by reason of interrupted descending aorta. The postoperative course was uneventful.
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Weber et al. (2019) conducted a case report in Severe aortic stenosis with history of aortic coarctation repair and extra-anatomic bypasses (n=1). Open aortic valve replacement with cardiopulmonary bypass prior to re-sternotomy was evaluated on Postoperative course. Open aortic valve replacement with cardiopulmonary bypass prior to re-sternotomy was successfully performed with an uneventful postoperative course in a high-risk patient with extra-anatomic bypasses.
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