Aortic valve bypass for high-risk patients with symptomatic aortic stenosis: A case report.

There are a significant number of symptomatic aortic stenosis (AS) patients not referred to the traditional methods for some complex conditions. We described a case of a 61-year-old female with severe symptomatic AS, calcific small aortic annulus (16.6 mm), narrow porcelain ascending aorta (aortic root: 14.6 mm, internal diameter: 14.0 mm), chronic renal insufficiency, and a history of the previous sternotomy for mechanical mitral valve replacement and coronary artery bypass grafting who underwent aortic valve bypass (AVB) with favorable results. AVB has been proposed as a complementary to surgery operation of aortic valve replacement and transcatheter aortic valve implantation in high-risk AS patients.

MUGA Scan of Apicoaortic Conduit with Incidental Finding of Pseudoaneurysm and Repeat Scan After Aneurysmectomy.

This is a case of a 77-year-old woman who underwent a multiple-gated acquisition (MUGA) scan to evaluate her cardiac function after initially presenting with chest pain and shortness of breath. The scan revealed the presence of an apicoaortic conduit (AAC) and incidentally found a left ventricular pseudoaneurysm. After aneurysmectomy, the MUGA scan was repeated.

Apical Aortic Conduit Infection 27 Years After Repaired Left Ventricular Outflow Tract Obstruction.

Left ventricle to aortic conduits were used for the treatment of complex left ventricular outflow tract obstruction in the pediatric population in the mid-1970s. Although this technique has been largely replaced by the Ross-Konno procedure, many patients still have functioning apicoaortic conduits in place today. Few clinical reports or case series exist in pediatric cohorts documenting the natural history or potential long-term complications of this prosthesis. In this report, we describe our experience managing a patient with Shone's syndrome and an apical aortic porcine-valved conduit remnant that became infected 17 years postconduit valve excision for valvular insufficiency.

Aortic valve bypass: experience from Denmark.

OBJECTIVES: In aortic valve bypass (AVB) a valve-containing conduit is connecting the apex of the left ventricle to the descending aorta. Candidates are patients with symptomatic aortic valve stenosis rejected for conventional aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI). During the last one and a half year, 10 patients otherwise left for medical therapy have been offered this procedure. We present the Danish experiences with the AVB procedure with a focus on patient selection, operative procedure and short-term results. METHODS: AVB is performed through a left thoracotomy. A 19-mm Freestyle(®) valve (Medtronic) is anastomosed to a vascular graft and an apex conduit. The anastomosis to the descending aorta is made prior to connecting the conduit to the apex. In 1 patient, we used an automated coring and apical connector insertion device (Correx(®)). The device results in a simultaneous coring and insertion of an 18-mm left ventricle connector in the apical myocardium. AVB is routinely performed without circulatory assistance. RESULTS: Ten patients have been operated on since April 2011: eight females and 2 males with a median age of 76 (65-91) years. Seven patients had a severely calcified ascending aorta. Three of these had previously had a sternotomy, but did not have an AVR because of porcelain aorta. Six patients had a very small left ventricle outflow tract (<18 mm). The median additive EuroSCORE was 12 (10-15). Seven patients were operated on without circulatory assistance. Two patients had a re-exploration for bleeding and 1 developed a ventricle septum defect 1 month postoperatively and was treated with surgical closure. The median follow-up was 7 (2-15) months and was without mortality. New York Heart Association class was reduced from 2.5 to 2 at the follow-up, but some patients were still in the recovery period. The total valve area (native plus conduit) was 2.2 (1.9-2.5) cm(2) and 1.34 (1.03-1.46) cm(2)/m(2), indexed to the body surface area. There was no AV block or stroke. CONCLUSIONS: AVB can be performed with low mortality and acceptable results in selected patients. The procedure can be offered to patients rejected for conventional aortic valve replacement and TAVI and results in a larger total valve area than by insertion of standard bioprosthesis.

Apicoaortic Conduit Bypass Surgery for Severe Calcific Aortic Valve Stenosis / 日本心臓血管外科学会雑誌

We report a case of a 79-year-old woman who underwent apicoaortic conduit bypass (ACB) surgery for severe calcific aortic valve stenosis. We did not perform conventional aortic valve replacement because of the patient's advanced age and because she had a small aortic annulus (17 mm) and a high risk of bleeding and cerebral infarction. ACB surgery through a left thoracotomy was performed via a femorofemoral bypass. A hand-made valve conduit was made from the left ventricular apex to the descending aorta. Her postoperative course was uneventful ; postoperative echocardiography showed a decreased pressure gradient at the native aortic valve between the left ventricle and the aorta. This procedure is useful in high-risk patients with severe calcified aortic valve stenosis.

Apicoaortic Conduit for Aortic Valve Stenosis after Coronary Bypass Grafting / 日本心臓血管外科学会雑誌

The patient was a 74-year-old man with a history of previous aorto-coronary bypass grafting 14 years previously. Echocardiography showed severe aortic valve stenosis. Computed tomography showed severe circumferential aortic calcification of the whole aorta, including the aortic root. Coronary cineangiography showed patency of the endoric graft. Avoiding graft injury and aortic cross clamping, we performed apicoaortic conduit. His postoperative course was uneventful, he was discharged very much improved on the 11th postoperative day. This procedure is useful in high risk patients with aortic valve stenosis.