Combined nephrectomy and aortic valve replacement: perioperative decision-making

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.