Management of aortic valve bypass surgery.

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Interventional Cardiology

Background:

• Aortic stenosis (AS) is primarily caused by calcific degeneration of trileaflet or bicuspid aortic valves, or rheumatic heart disease.
• Severe AS necessitates intervention, with options including aortic valve replacement (AVR), transcatheter aortic valve implantation (TAVI), or aortic valve bypass (AVB).
• Aortic valve bypass (AVB) is a valuable alternative for high-risk patients unsuitable for AVR or TAVI due to comorbidities like porcelain aorta, prior cardiac surgery, or severe aorto-iliac disease.

Observation:

• AVB involves creating a conduit from the left ventricular apex to the descending thoracic aorta.
• On-pump AVB offers advantages such as avoiding aortic cannulation, cross-clamping, and cardioplegic arrest.
• The procedure can be performed without cardiopulmonary bypass, enhancing its applicability.

Findings:

• This review examines the circulatory physiology, anesthetic management, intraoperative transesophageal echocardiography use, and surgical considerations of AVB.
• Three case studies illustrate the application and outcomes of AVB surgery.

Implications:

• AVB provides a crucial treatment option for complex aortic stenosis cases.
• Understanding AVB's unique benefits and management is essential for cardiothoracic surgeons and anesthesiologists.
• Further research into AVB techniques and patient selection may expand its role in managing severe AS.