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


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Abstract

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.

About the authors

D. V. Borisov

Federal research Clinical center for specialized types of health care and medical technologies of Federal Medical and Biology Agency

Author for correspondence.
Email: zotov.alex.az@gmail.com

врач-сердечно-сосудистый хирург

Russian Federation, 28, Orekhovy boulevard, Moscow, 115682

A. S. Zotov

Federal research Clinical center for specialized types of health care and medical technologies of Federal Medical and Biology Agency

Email: zotov.alex.az@gmail.com

канд. мед. наук, заведующий отделением кардиохирургии

Russian Federation, 28, Orekhovy boulevard, Moscow, 115682

S. A. Vachev

Federal research Clinical center for specialized types of health care and medical technologies of Federal Medical and Biology Agency

Email: zotov.alex.az@gmail.com

канд. мед. наук, врач-сердечно-сосудистый хирург

Russian Federation, 28, Orekhovy boulevard, Moscow, 115682

A. V. Troitskiy

Federal research Clinical center for specialized types of health care and medical technologies of Federal Medical and Biology Agency

Email: zotov.alex.az@gmail.com

доктор мед. наук, профессор, генеральный директор

Russian Federation, 28, Orekhovy boulevard, Moscow, 115682

R. I. Khabazov

Federal research Clinical center for specialized types of health care and medical technologies of Federal Medical and Biology Agency

Email: zotov.alex.az@gmail.com

доктор мед. наук, профессор, главный врач

Russian Federation, 28, Orekhovy boulevard, Moscow, 115682

References

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  2. Al-Adhami A and Al-Attar N. Recent advances in aortic valve replacement for aortic stenosis [version 1; referees: 2 approved] F1000Research 2016, 5(F1000 Faculty Rev):2542 (doi: 10.12688/ f1000research.8728.1).
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  4. Head S J, Mokhles M M, Osnabrugge R L, et al: The impact of prosthesis-patient mismatch on long-term survival after aortic valve replacement: A systematic review and meta-analysis of 34 observational studies comprising 27,186 patients with 133,141 patient-years. Eur Heart J33 (12):1518–1529, 2012.
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  6. Kulik A, Al-Saigh M, Chan V, et al: Enlargement of the small aortic root during aortic valve replacement: Is there a benefit? Ann Thorac Surg 85 (1): 94–100, 2008.
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  9. Dhareshwar J, Sundt 3rd T M, Dearani J A, Schaff H V, Cook D J, Orszulak T A: Aortic root enlargement: what are the operative risks? J Thorac Cardiovasc Surg 134 (4): 916–924, 2007.
  10. Coutinho GF, Correia PM, Pauperio G, de Oliveira F, Antunes MJ. Aortic root enlargement does not increase the surgical risk and short-term patient outcome? Eur J Cardiothorac Surg 2011;40;441-7. http://doi.org/bsjp23.
  11. Grubb K.J. Aortic Root Enlargement During Aortic Valve Replacement: Nicks and Manouguian Techniques. Operative Techniques in Thoracic and Cardiovascular Surgery, Volume 20 , Issue 3 , 206 – 218.

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2. Fig.1. (adapted from [1]). ACC / AHA guidelines for the management of patients with aortic valve stenosis (2014). AS - aortic stenosis, LV LV - left ventricular ejection fraction, TFN - exercise tolerance, PAK - aortic valve replacement, DSE - dobutamine stress-ECHO-KG, OAK - aortic valve opening.

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3. Fig. 2. A. The aortic root is dissected in the middle of the non-coronary sinus to the level of the basal ring, a wedge-shaped xenopericard patch is implanted in this area.

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4. Fig. 2. B. General view of the aortic root after expansion.

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Copyright (c) 2018 Borisov D.V., Zotov A.S., Vachev S.A., Troitskiy A.V., Khabazov R.I.

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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