title: Management of aortic valve bypass surgery.
abstract: The 3 leading causes of aortic stenosis (AS) in adults are calcific degeneration of a normal trileaflet aortic valve (AV), calcific degeneration of a congenital bicuspid AV, and rheumatic AS. Therapeutic options in patients with severe AS include aortic valve replacement (AVR), transcatheter aortic valve implantation (TAVI), or aortic valve bypass (AVB). An AVB involves the placement of a valved conduit between the apex of the left ventricle and the descending thoracic aorta. AVB serves as a useful alternative to treat severe AS in patients deemed high risk for conventional AVR (ie, porcelain aorta, previous cardiac surgery) or TAVI (ie, severe aorto-iliac disease, limited experience, lack of hybrid operating room). Advantages of on-pump AVB include the avoidance of aortic cannulation, cross-clamping, and cardioplegic cardiac arrest. The procedure can also be performed without cardiopulmonary bypass. In this article, the authors review the circulatory physiology, perioperative anesthetic management, the role of intraoperative transesophageal echocardiography, and surgical considerations of AVB surgery through 3 cases.
authors.affiliation: Department of Anesthesiology, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC 29401, USA. tamas.szabo@va.gov
authors.forename: Tamas A
authors.initials: TA
authors.lastname: Szabo
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Toole
authors.forename: Kim J
authors.initials: KJ
authors.lastname: Payne
authors.forename: Erica M
authors.initials: EM
authors.lastname: Giblin
authors.forename: Samuel P
authors.initials: SP
authors.lastname: Jacks
authors.forename: R David
authors.initials: RD
authors.lastname: Warters
mesh_terms: D000368:Aged; D000758:Anesthesia / Q000379:methods; D001021:Aortic Valve / Q000502:physiology / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D047549:Coronary Artery Bypass, Off-Pump; D003324:Coronary Artery Disease / Q000503:physiopathology / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D017548:Echocardiography, Transesophageal; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007430:Intraoperative Care; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D013908:Thoracotomy