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| 17F-004 | Video session발표 |
Sutureless Aortic Valve Replacement as an Affordable Alternative Option for a High-risk Patient with Previous Coronary Artery Bypass Grafting
Jae Suk Yoo
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Republic of Korea
Purpose : We report the case of successful sutureless aortic valve replacement (AVR) in a high-risk patient who cannot afford to undergo transcatheter aortic valve implantation (TAVI).
Methods : An 80-year-old woman who had undergone a coronary artery bypass grafting (CABG) 11 years earlier was now diagnosed with severe aortic stenosis with pulmonary edema. Computed tomography revealed patent coronary artery bypass grafts with multiple calcification at ascending aorta (Figure). Two saphenous vein grafts were arising from the mid-ascending aorta where a usual aortotomy is made during AVR. Although TAVI was recommended for the high surgical risk, she refused for the financial problem. Since a conventional AVR was thought to carry a higher risk and technical difficulties a sutureless AVR was performed. Since there were multiple ahterosclerosis and calcification in abdominal aorta, cardiopulmonary bypass was conducted through right axillary artery and right femoral vein.
Results : Sutureless aortic valve (Edwards Intuity Elite Valve System) was implanted through an uncommon aortotomy not to injure the saphenous vein grafts. Cardiopulmonary bypass weaning was difficult due to the ischemic insult on the left anterior descending coronary artery territory, thus venoarterial extracorporeal membrane oxygenation (ECMO) support was performed using the axillary artery and femoral vein cannulas. The patient was weaned off ECMO on the second postoperative day, and extubated on the third postoperative day. The patient was discharged on the 10th postoperative day.
Conclusion : Sutureless aortic valve could be an alternative option for a high-risk patient who cannot afford to undergo TAVI.
Methods : An 80-year-old woman who had undergone a coronary artery bypass grafting (CABG) 11 years earlier was now diagnosed with severe aortic stenosis with pulmonary edema. Computed tomography revealed patent coronary artery bypass grafts with multiple calcification at ascending aorta (Figure). Two saphenous vein grafts were arising from the mid-ascending aorta where a usual aortotomy is made during AVR. Although TAVI was recommended for the high surgical risk, she refused for the financial problem. Since a conventional AVR was thought to carry a higher risk and technical difficulties a sutureless AVR was performed. Since there were multiple ahterosclerosis and calcification in abdominal aorta, cardiopulmonary bypass was conducted through right axillary artery and right femoral vein.
Results : Sutureless aortic valve (Edwards Intuity Elite Valve System) was implanted through an uncommon aortotomy not to injure the saphenous vein grafts. Cardiopulmonary bypass weaning was difficult due to the ischemic insult on the left anterior descending coronary artery territory, thus venoarterial extracorporeal membrane oxygenation (ECMO) support was performed using the axillary artery and femoral vein cannulas. The patient was weaned off ECMO on the second postoperative day, and extubated on the third postoperative day. The patient was discharged on the 10th postoperative day.
Conclusion : Sutureless aortic valve could be an alternative option for a high-risk patient who cannot afford to undergo TAVI.
책임저자: Jae Suk Yoo
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Gyeonggi-do, Republic of Korea
발표자: Jae Suk Yoo, E-mail : mdyoo77@gmail.com