Partial inferior sternotomy and deep hypothermic circulatory arrest for rescue of a failed TAVI case: what does constitute 'inoperable'?
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.
Clinic of Cardiac Surgery, Ludwig Maximilian University - Munich, Campus Grosshadern, Munich, Germany. reneschramm@live.de
René
R
Schramm
Helmut
H
Mair
Christoph
C
Becker
Florian
F
Schwarz
René
R
Bombien
Gerd
G
Juchem
Ralf
R
Sodian
Christian
C
Kupatt
Christoph
C
Schmitz
D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D001026:Coronary Artery Bypass / Q000009:adverse effects; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D018579:Patient Selection; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure