Rapid-Deployment Aortic Valve Replacement for a Hemodialysis Patient with Prior Coronary Artery Bypass Grafting

Authors

  • Taira Yamamoto, PhD Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
  • Daisuke Endo, PhD Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
  • Hironobu Yamaoka, PhD Department of Cardiovascular Surgery, Edogawa Hospital, Tokyo, Japan
  • Akie Shimada, PhD Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
  • Satoshi Matsushita, PhD Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
  • Atsushi Amano, PhD Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan

DOI:

https://doi.org/10.1532/hsf.3535

Keywords:

Aortic valve replacement redo-cardiac surgery, Hemodialysis, Rapid-deployment aortic valve, Intuity system, saphenous vein graft

Abstract

Background: Aortic valve reoperation increases the risk of mortality and morbidity. The 2017 European Society of Cardiology guidelines for managing valvular heart disease with a previous heart surgery and intact bypass grafts consider patients with high surgical risk to be injury-prone during sternotomy. In high-risk patients with prior coronary artery bypass grafting, several authors have reported the noninferiority or superiority of transcatheter aortic valve replacement (TAVR) compared with surgical aortic valve replacement; however, in Japan, TAVR cannot be performed for patients on hemodialysis. In this study, we report a case of successful implantation of the new rapid-deployment bioprosthesis in a 65-year-old Japanese man on dialysis with prior coronary artery bypass grafting.

Methods: The rapid-deployment aortic valve system has demonstrated excellent hemodynamic performance, durability, and safety. However, implantation requires specific training and the analysis of preoperative 3D computed tomographic imaging. The cineangiography revealed patency of all grafts, and the saphenous vein graft (SVG) had overlapped the planned aortotomy position. By avoiding the anastomotic part of the SVG, we could perform rapid-deployment aortic valve replacement efficiently even if the aortic incision was repositioned, and the incision was smaller than planned.

Results: We used the 23-mm Intuity valve without an additional stitch, and the cardiopulmonary bypass and aortic cross-clamp times were only 52 and 39 minutes, respectively.

Conclusion: This novel valve may be beneficial in complex combinational procedures for hemodialysis patients with prior coronary artery bypass grafting.

References

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Published

2021-06-11

How to Cite

Yamamoto, T., Endo, D. ., Yamaoka , H., Shimada, A., Matsushita, S., & Amano, A. . (2021). Rapid-Deployment Aortic Valve Replacement for a Hemodialysis Patient with Prior Coronary Artery Bypass Grafting. The Heart Surgery Forum, 24(3), E530-E533. https://doi.org/10.1532/hsf.3535

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