title: Coronary ostial compromise in aortic valve replacement: an avoidable complication.
abstract: BACKGROUND
  We sought to determine the incidence of hospital death due to surgical compromise of the coronary ostia in aortic valve replacement. The mechanism of coronary ostium blockage was also investigated.
  
  
  METHODS
  A retrospective review was conducted of prospectively collected clinical data and autopsy findings in 322 patients who died in hospital after aortic valve replacement with or without concomitant procedures in a single institution from January 1998 to March 2013.
  
  
  RESULTS
  Over the 15-year period, more than 17 surgeons performed 7507 aortic valve replacements with or without other procedures. The mean age of the patients was 70.8 ± 11.78 years and 63% were male. Bioprosthetic valves were used in 75%, mechanical valves in 24.7%, and homografts in only 0.3%. Early mortality for all patients (combined, emergency, and redo procedures) was 4.29% (mean logistic EuroSCORE 10.7). There were 322 deaths after procedures involving the aortic valve. Autopsy examinations were carried out in all patients and showed that 3.4% (n = 11) of deaths were at least partly attributed to encroachment on one or both coronary ostia. Causes of ostial compromise included the valve sutures, the valve sewing ring, and the aortotomy suture line.
  
  
  CONCLUSIONS
  Coronary ostial compromise in aortic valve replacement is a very rare but real problem occurring in at least 0.15% of aortic valve replacements and contributing to or directly causing one in every 29 aortic valve replacement deaths. Surgeons should have a high level of awareness of the risk of this rare but fatal and avoidable complication.
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK shakil_farid74@yahoo.com.
authors.forename: Shakil
authors.initials: S
authors.lastname: Farid
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Aravinda
authors.initials: A
authors.lastname: Page
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Howell
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Martin
authors.initials: M
authors.lastname: Goddard
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Abu-Omar
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: David P
authors.initials: DP
authors.lastname: Jenkins
authors.affiliation: Department of Cardiothoracic Surgery, Papworth Hospital NHS Foundation Trust, Cambridge, UK.
authors.forename: Samer Am
authors.initials: SA
authors.lastname: Nashef
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D001344:Autopsy; D023921:Coronary Stenosis / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D012189:Retrospective Studies
keywords: Aortic valve; coronary stenosis; heart valve diseases; heart valve prosthesis implantation; postoperative complications