title: Combined nephrectomy and aortic valve replacement: perioperative decision-making.
abstract: Open heart surgery and urologic surgery may be required for patients with coincident diseases. We report a patient who suffered from aortic valve stenosis which was asymptomatic barring atrial fibrillation. He was prescribed warfarin and then developed a large perinephric hematoma. The perioperative considerations focused on whether to conduct aortic valve replacement for this patient and, if such surgery was indicated, the appropriate time to conduct it. Traditionally, severe cardiac disease is addressed first before conducting elective noncardiac surgery; however, this option was not available since the patient already had a perinephric hematoma which could bleed more when subjected to systemic heparinization for cardiopulmonary bypass. Here, we describe the process of perioperative decision-making involving multiple specialities and re-examine several guidelines.
authors.affiliation: Department of Anesthesiology and Critical Care, JIPMER, Qr. No. D(II) 18, JIPMER Campus, Puducherry, 605006, India.
authors.forename: N C
authors.initials: NC
authors.lastname: Pankaj Kumar
authors.affiliation: Department of Anesthesiology and Critical Care, JIPMER, Qr. No. D(II) 18, JIPMER Campus, Puducherry, 605006, India. jipmersatyen@gmail.com.
authors.forename: Satyen
authors.initials: S
authors.lastname: Parida
authors.affiliation: Department of Anesthesiology and Critical Care, JIPMER, Qr. No. D(II) 18, JIPMER Campus, Puducherry, 605006, India.
authors.forename: Ashok Shankar
authors.initials: AS
authors.lastname: Badhe
authors.affiliation: Cardiothoracic and Vascular Surgery, JIPMER, Puducherry, India.
authors.forename: B V
authors.initials: BV
authors.lastname: Sai Chandran
mesh_terms: D001021:Aortic Valve / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*
keywords: Cardiopulmonary bypass; Combined procedure; Nephrectomy