Concomitant use of Sapien 3 transcatheter valve for severe MAC with Intuity Elite rapid deployment valve for aortic stenosis.

BACKGROUND: Concomitant double valve pathology in the presence of severe MAC poses significant technical challenges when planning surgical intervention. With continued evolution of valve prosthesis, innovative techniques can be considered with the potential for additional therapeutic benefit. CASE PRESENTATION: We present a novel technique of using a rapid deployment surgical aortic valve in combination with open surgical transcatheter mitral valve implantation (TMVI) for severe Mitral Annular Calcification (MAC). The Intuity Elite rapid deployment prosthesis (Edwards Lifesciences, Irvine, CA) was used concomitantly with the Sapien 3 (Edwards Lifesciences, Irvine, CA) transcatheter prosthesis trans-atrially on cardiopulmonary bypass in a patient with critical aortic stenosis and moderate-severe mixed mitral valve disease in the setting of severe MAC (off-label use). CONCLUSIONS: We demonstrate how both technologies can, not only be accommodated, but indeed complement each other achieving an excellent outcome in a high-risk patient.

Non-surgical bleeding in cardiac surgery.

Bleeding is an occurrence stemming from complex interactions encountered in cardiac surgery and is often attributed to the perioperative administration of anti-thrombotic products if inadequate surgical haemostasis is excluded. Very occasionally, bleeding does not fit the norm and the aetiology is not a lack of surgical prolene or an iatrogenic-induced coagulopathy. Patients who present for cardiac surgery should be questioned carefully for a history of bleeding; however, patients at risk are not always identified. This case presents a series of haemorrhagic events incorrectly labelled as surgical complications resulting from an uncommon but not insignificant undiagnosed condition. The existing literature outlining protocols to safely manage patients with haemophilia during the perioperative cardiac surgical period is discussed in this report. This case explicitly demonstrates the importance of preoperative identification to avoid the morbidity that can result from cardiac surgery in an undiagnosed haemophilic patient.

A novel approach: how an intracoronary shunt proved to be lifesaving.

Outcomes and complications following internal massage in cardiac surgery are unknown due to the lack of cumulative effort to capture those events and subsequently developing a registry. Therefore, under the circumstances there are no algorithms defined in the literature. This case report outlines the importance of sound decision-making under pressure in order to achieve a favourable outcome. A potential solution is outlined to a very complex and rare problem: anastomotic disruption during internal cardiac massage in an intensive care unit setting, demonstrating the use of an intracoronary shunt for initial stabilization prior to a definitive procedure.