Simultaneous Aortic Valve Replacement and Percutaneous Transluminal Angioplasty. Single Center Initial Experience

Objective. The incidence of cardiac valve disease and concomitant coronary and/or carotid artery disease increases with age.
The presence of carotid disease in patients undergoing cardiac surgery under cardiopulmonary bypass has been known to increase the risk of perioperative stroke. In patients with critical aortic valve stenosis and carotid artery disease we did simultaneous aortic valve replacement and carotid artery stenting.
~40% of patients with valvular heart disease have concomitant coronary artery disease. The combined operation (aortic valve replacement and CABG) carries an increased risk of mortality over isolated aortic valve replacement. According to 2014 ESC/EACTS Guidelines on myocardial revascularization as an alternative treatment for high risk patients is accteptable hybrid aortic valve replacement and percutaneous coronary intervention, however the available evidence is still limited.
Herein we describe first 3 cases with simultaneous aortic valve replacement and percutaneous transluminal angioplasty.
Methods. From May 2013 to July 2013 in our heart surgery department were performed three simultaneous aortic valve replacements and percutaneous transluminal angioplasties of carotid artery (2 cases) or of right coronary artery (1 case). In the last case aortic valve replacement was performed throught upper partial sternotomy because of severe obesity (BMI 39,1kg/m2). Heparin 1mg/kg was administred immediately before angioplasty and 2mg/kg as a bolus before cardiopulmonary bypass was started. Aspirin 100mg was started in intensive care unite 5-20 hours after the end of surgery. Mean age (mean±SD) 74±3,7 years, 1 female patient. Data are given as mean± standard deviation (SD).
Results. The mean aortic valve area was 0,6 cm2 and mean pressure gradient 52,5±7,5 mmHg. The mean operation time was 240±14,7 minutes, mean cardiopulmonary bypass time was 124±22,7 minutes and the mean aortic cross-clamp time was 65±3,4 minutes. No patients had postoperative bleeding requiring reintervention. Maximum troponin I level on the day of operation was 4,7±3,2 ng/ml and on the first postoperative day it was 3,4±1,8. There was no trombembolic events during hospital stay. The mean hospital stay after surgery was 11,0±2,9 days.
Conclusions. Simultaneous surgical aortic valve replacement through partial strnotomy and percutaneous coronary angioplasty can be a method of treatment for patients with concomitant critical aortic valve pathology and coronary artery disease and who might benefit from maintened part of sternum.
In patients with critical aortic valve stenosis and carotid disease can be considered simultaneous surgical aortic valve replacement and carotid artery stenting when the staged treatment is too risky.