Partial Inferior Sternotomy and Deep Hypothermic Circulatory Arrest for Rescue of a Failed TAVI Case: What Does Constitute ‘Inoperable’?

Abstract

A 65-year-old male patient was considered inoperable by conventional means for a previous triple coronary artery bypass grafting with a patent in situ right internal mammary artery graft to the left anterior descending artery crossing the thorax at midline directly behind the sternum. Transcatheter aortic valve implantation failed due to loss of the prosthetic device in the left ventricular outflow tract. Mandatory conversion was accomplished by an inferior partial T-shape sternotomy and extracorporeal circulation draining from the right atrium and feeding into the right femoral artery. A conventional 27-mm aortic valve bioprosthesis was successfully implanted during deep hypothermic circulatory arrest. The patient recovered normally exhibiting no neurological or cardiocirculatory complications.

Keywords

heart valve - transapical - percutaneous transcatheter aortic valve implantation - coronary artery bypass grafts surgery - coronary artery bypass grafting - cardiac

• References

• 1 Vahanian A, Baumgartner H, Bax J , et al; Task Force on the Management of Valvular Hearth Disease of the European Society of Cardiology; ESC Committee for Practice Guidelines. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007; 28 (2) 230-268
• 2 Bonow RO, Carabello BA, Chatterjee K , et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006; 48: 1-148
• 3 Vahanian A, Alfieri O, Al-Attar N , et al; European Association of Cardio-Thoracic Surgery; European Society of Cardiology; European Association of Percutaneous Cardiovascular Interventions. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European association of cardio-thoracic surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2008; 29 (11) 1463-1470
• 4 Khaladj N, Shrestha M, Peterss S , et al. Isolated surgical aortic valve replacement after previous coronary artery bypass grafting with patent grafts: is this old-fashioned technique obsolete?. Eur J Cardiothorac Surg 2009; 35 (2) 260-264 , discussion 264
• 5 Redlich K, Khaladj N, Peterss S , et al. Conventional aortic valve replacement in patients with concomitant coronary artery disease and previous coronary artery bypass grafting in the era of interventional approaches. Eur J Cardiothorac Surg 2011; 40 (2) 455-462
• 6 Ladich E, Michaels MB, Jones RM , et al; Endovascular Valve Edge-to-Edge Repair Study (EVEREST) Investigators. Pathological healing response of explanted MitraClip devices. Circulation 2011; 123 (13) 1418-1427
• 7 Lange R, Bleiziffer S, Piazza N , et al. Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients. Eur J Cardiothorac Surg 2011; 40 (5) 1105-1113