title: Anesthetic management of apicoaortic bypass in patients with severe aortic stenosis.
abstract: Apicoaortic bypass (AAB), or apicoaortic conduit insertion, is a conventional surgical method that has been regaining attention due to the aging population and the increasing number of repeat surgeries. The indication for the procedure has been extended as an alternative for aortic stenosis when the usual sternotomy or aortic clamping is considered to be difficult, e.g., in patients with severe calcification of the ascending aorta (porcelain aorta), or in patients with a patent coronary artery bypass graft located adjacent to the posterior surface of the sternum. Herein, we report our recent anesthetic management of three patients undergoing AAB. Once the apicoaortic conduit is inserted, blood from the left ventricle is ejected via two routes, the narrowed native aortic valve and the apicoaortic conduit. Thus, it is necessary to elucidate any change in blood flow after the withdrawal of the extracorporeal circulation, by using intraoperative transesophageal echocardiography. Furthermore, if a rigid apical connector is not used, anastomosis of the cardiac apex and conduit is conducted under ventricular fibrillation without the infusion of cardioplegic solution; thus, patients are deemed likely to suffer increased myocardial damage. As a rigid apical connector was not used in the three present patients, the administraction of adequate catecholamines was needed for the withdrawal of the extracorporeal circulation. In addition, because those undergoing AAB often have extremely poor cardiac reserve preoperatively owing to the administration of adequate catecholamines was needed for the withdrawal of the extracorporeal circulation. In the three present patients, anesthetic management was successful, and there were no intraoperative or immediate postoperative complications.
authors.affiliation: Department of Anesthesiology, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 534-0021, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Ogawa
authors.forename: Ryu
authors.initials: R
authors.lastname: Okutani
authors.forename: Tatsuhiro
authors.initials: T
authors.lastname: Shigemoto
authors.forename: Koji
authors.initials: K
authors.lastname: Hattori
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ide
mesh_terms: D000368:Aged; D000758:Anesthesia; D000768:Anesthesia, General; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000151:congenital / Q000473:pathology / Q000601:surgery*; D001026:Coronary Artery Bypass; D003928:Diabetic Nephropathies / Q000150:complications; D017548:Echocardiography, Transesophageal; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D014057:Tomography, X-Ray Computed
references.citation: Am Heart J. 2001 Apr;141(4):630-6
references.pmid: 11275931
references.citation: Gen Thorac Cardiovasc Surg. 2007 Sep;55(9):370-1
references.pmid: 17937051
references.citation: Ann Thorac Surg. 2000 May;69(5):1511-4
references.pmid: 10881832
references.citation: J Thorac Cardiovasc Surg. 2006 Jul;132(1):155-6
references.pmid: 16798319
references.citation: Anesth Analg. 2007 Sep;105(3):583-601
references.pmid: 17717209
references.citation: Circulation. 2008 Sep 30;118(14):1460-6
references.pmid: 18794389
references.citation: Cardiovasc Dis. 1975;2(4):376-383
references.pmid: 15216010
references.citation: Tex Heart Inst J. 2000;27(1):24-8
references.pmid: 10830624
references.citation: Eur J Cardiothorac Surg. 2003 Feb;23(2):156-8
references.pmid: 12559335
references.citation: J Thorac Cardiovasc Surg. 2006 Oct;132(4):796-801
references.pmid: 17000290
references.citation: Interact Cardiovasc Thorac Surg. 2007 Jun;6(3):374-5
references.pmid: 17669869
references.citation: Gen Thorac Cardiovasc Surg. 2007 Jun;55(6):240-2
references.pmid: 17642277