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Published on: May 21, 2017
[Mitral Valve Replacement Under Cardiac Arrest Using Systemic Hyperkalemia in a Patient with Atheromatous Aorta]
Atsushi Yano1, Kouhei Ishido, Toshio Katsube
1Department of Cardiovascular Surgery, Sakakibara Heart Institute, Fuchu, Japan.
Insights
This study presents a successful mitral valve replacement and coronary artery bypass grafting using systemic hyperkalemia. This technique avoided aortic clamping, preventing neurological complications in a patient with severe aortic atheroma.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
Background:
- A 78-year-old male presented with heart failure, severe mitral regurgitation, and coronary artery disease.
- Severe atheromatous ascending aorta posed a contraindication for aortic clamping during surgery.
Purpose of the Study:
- To describe a novel surgical approach for mitral valve replacement and coronary artery bypass grafting in a patient with a severely atheromatous aorta.
- To evaluate the safety and efficacy of systemic hyperkalemia-induced cardiac arrest without aortic cross-clamping.
Main Methods:
- The patient underwent mitral valve replacement and coronary artery bypass grafting under mild hypothermia.
- Cardiac arrest was achieved using systemic hyperkalemia, with a superior transseptal approach utilized.
- Aortic cross-clamping was avoided, and cardiopulmonary bypass (CPB) time was managed with dilutional ultrafiltration to remove potassium.
Main Results:
- The surgical procedure was completed successfully without aortic cross-clamping.
- The patient was uneventfully separated from cardiopulmonary bypass.
- No neurological complications were observed, and the patient was discharged 15 days post-surgery.
Conclusions:
- Mitral valve replacement using systemic hyperkalemia-induced cardiac arrest without aortic cross-clamping is a viable and safe alternative.
- This technique is particularly beneficial in patients with contraindications to aortic clamping, such as severe aortic atheroma.
- The approach effectively mitigates the risk of neurological complications associated with aortic manipulation.
Abstract:
We report a successful case of mitral valve replacement and coronary artery bypass grafting under mild hypothermia and systemic hyperkalemia in a patient with severely atheromatous ascending aorta on which placing a clamp seemed contraindicated. A 78-year-old man was referred to our hospital with the diagnosis of heart failure associated with severe mitral regurgitation and coronary artery disease. Echocardiography showed severe mitral regurgitation due to A3, P3 and posterior commissure (PC) prolapse and coronary angiography showed three vessel disease. Computed tomography( CT) revealed a severely atheromatous ascending aorta. Surgery was performed under cardiac arrest using systemic hyperkalemia and superior transseptal approach. Although cardiopulmonary bypass (CPB) time was a little prolonged in order to wash out potassium with dilutional ultrafiltration, the patient was uneventfully separated from CPB. The patient had no neurological complications and was discharged from the hospital 15 days after surgery. Mitral valve replacement under cardiac arrest using systemic hyperkalemia without cross clamping the aorta is useful to avoid neurological complications.
