Postperfusion coronary ostial stenosis: incidence and significance

In a study of 117 consecutive aortic valve replacements in which selective coronary perfusion was routinely employed, four patients developed coronary ostial stenosis (3.5 per cent). Continuous selective coronary perfusion was performed by use of Mayo balloon catheters with individual measuring of pressure and flow. All 4 patients developed progressive symptoms of angina pectoris within 6 months of the original operation, after uneventful recoveries. All 4 were found to have lesions in the left main coronary ostium and required a coronary bypass. Two made uneventful recoveries and are presently asymptomatic, whereas 2 died in the immediate postoperative period. The literature indicates that the reported incidence of this complication varies from 1 to 5 per cent. Furthermore, the mortality rate for reoperation in these patients is higher than that for those undergoing uncomplicated coronary bypass without an antecedent procedure. Our experience confirms the lethal nature of this complication and the necessity for reoperation once the diagnosis is established. The development of these dangerous lesions must be taken into account in the prevailing controversy between the most effective methods of myocardial protection during aortic valve replacement.