[Apico-aortic conduit for severe aortic stenosis in elderly]
T Takemura1, Y Shimamura, M Sakaguchi
1Department of Cardiovascular Surgery, National Nagano Hospital, Ueda, Japan.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|December 16, 2003
Summary
An 84-year-old woman with severe aortic stenosis and heart failure underwent a successful apico-aortic conduit bypass. This procedure offers a viable option for elderly patients unsuitable for traditional valve replacement.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Geriatric Medicine
Background:
- Severe aortic stenosis poses significant risks, especially in elderly patients with comorbidities.
- Conventional aortic valve replacement may not be suitable for all patients due to age and anatomical challenges.
- This case highlights the management of a complex patient with end-stage aortic stenosis, complete atrio-ventricular block, and respiratory insufficiency.
Observation:
- An 84-year-old female presented with symptoms refractory to pacemaker implantation for complete atrio-ventricular block.
- Echocardiography revealed a small aortic annulus and severe calcific aortic stenosis with a high transvalvular gradient (100 mmHg).
- The patient's condition rapidly deteriorated, leading to hypotension and acute renal failure, necessitating emergency intervention.
Findings:
- An emergency apico-aortic conduit bypass was successfully performed using a bioprosthetic valved conduit.
- The procedure involved anastomosing the conduit to the left ventricle apex and the descending thoracic aorta.
- The patient was discharged on postoperative day 57 without complications, despite requiring temporary hemodialysis.
Implications:
- Apico-aortic conduit bypass can be an effective alternative for high-risk elderly patients with severe aortic stenosis.
- This surgical approach may offer a favorable outcome when conventional valve replacement is contraindicated.
- The case underscores the importance of considering alternative surgical strategies for complex cardiovascular conditions in the elderly.
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