Aortic Valve Bypass for the High-Risk Patient With Aortic Stenosis

Gammie, James S.; Brown, John W.; Brown, Jamie; Poston, Robert; Pierson, Richard N.; Odonkor, Patrick; White, Charles S.; Gottdiener, John S.; Griffith, Bartley P.

doi:10.1016/j.athoracsur.2005.11.060

Cited by 53 publications

(35 citation statements)

References 21 publications

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“…Although the Ross-Kono procedure is now used for children with complex left ventricular outflow tract obstruction, 11 AVB surgery has been applied sporadically to high-risk adult patients with acquired AS, with just over 100 reported cases in the literature. 12 Beginning in 2003, we initiated a concentrated clinical experience in AVB surgery for high-risk AS patients at the University of Maryland. The purposes of this article are to update our clinical experience, 12 to characterize the hemodynamics of the circulation after construction of an AVB, to assess midterm outcomes, and to report lessons learned.…”

Section: Clinical Perspective P 1466mentioning

confidence: 99%

“…12 Beginning in 2003, we initiated a concentrated clinical experience in AVB surgery for high-risk AS patients at the University of Maryland. The purposes of this article are to update our clinical experience, 12 to characterize the hemodynamics of the circulation after construction of an AVB, to assess midterm outcomes, and to report lessons learned.…”

Section: Clinical Perspective P 1466mentioning

confidence: 99%

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Aortic Valve Bypass Surgery

et al. 2008

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Background-Aortic valve bypass (AVB; apicoaortic conduit) surgery relieves aortic stenosis (AS) by shunting blood from the apex of the left ventricle to the descending thoracic aorta through a valved conduit. We have performed AVB surgery as an alternative to conventional aortic valve replacement for high-risk AS patients. Methods and Results-Between 2003 and 2007, 31 high-risk AS patients were treated with AVB surgery. Twenty-two patients (71%) were undergoing reoperation with patent coronary bypass grafts, and 5 (16%) had a porcelain ascending aorta. The average age was 81 years. Cardiopulmonary bypass was used for 19 of 31 patients (61%); the median duration of cardiopulmonary bypass was 19 minutes. Cross-clamp time for all patients was 0 minutes. Perioperative mortality was 13% (4 of 31 patients); no perioperative deaths occurred in the last 16 consecutive patients. One patient experienced a stroke related to intraoperative hypotension. No strokes have occurred during follow-up. Renal function was unchanged after AVB (preoperative creatinine, 1.3Ϯ0.5 mg/dL; postoperative creatinine, 1.2Ϯ0.5 mg/dL). The mean gradient across the native aortic valve decreased from 43.5Ϯ15 to 10.4Ϯ5.4 mm Hg. Echocardiographically determined conduit flow expressed as a percentage of total cardiac output was 72Ϯ12%. Conclusions-AVB surgery is an important therapeutic option for high-risk patients with symptomatic AS. Ventricular outflow is distributed in a predictable fashion between the conduit and the left ventricular outflow tract, and AVB surgery reliably relieves AS. Stroke and renal dysfunction were uncommon.

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Section: Clinical Perspective P 1466mentioning

confidence: 99%

Section: Clinical Perspective P 1466mentioning

confidence: 99%

Aortic Valve Bypass Surgery

et al. 2008

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“…1 Aortic valve replacement (AVR) surgery has a significant positive impact on prognosis, yet many patients are denied conventional surgery because of age and comorbidities. 2 Aortic valve bypass (apicoaortic conduit) surgery 3 has been developed to provide definitive treatment with less surgical morbidity, but it requires general anesthesia and cannot be applied to the highest-risk patients. Balloon aortic valvuloplasty (BAV) can temporarily alleviate symptoms but does not provide sustained symptomatic benefit, and prognosis remains poor.…”

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confidence: 99%

Heart Failure and “Inoperable” Aortic Stenosis: Staged Balloon Aortic Valvuloplasty and Aortic Valve Bypass

Zimrin

Reyes

Miller

et al. 2008

Congestive Heart Failure

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The prognosis for patients with symptomatic aortic stenosis is poor but is improved significantly by surgical aortic valve replacement. Unfortunately, many patients are refused surgery because of age, comorbidities, and hemodynamic instability. This report describes the successful use of balloon aortic valvuloplasty as a bridge to aortic valve bypass surgery (apicoaortic conduit) in an elderly patient with class IV congestive heart failure and severe left ventricular systolic dysfunction as a consequence of aortic stenosis who was not a candidate for traditional surgical valve replacement.

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“…Either approach is associated with substantial morbidity and mortality. Recently, an aortic valve bypass procedure (apicoaortic coduit) has been applied to high risk patients in which a synthetic graft is placed between the left ventricular apex and descending aorta, diverting a proportion of blood flow around the stenotic valve [1]. In this report, we describe the imaging appearances of the aortic valve bypass on multidetector CT (MDCT) in 12 patients who underwent the procedure.…”

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confidence: 95%