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  • Title: Perioperative complications in combined aortic valve replacement and extraanatomic ascending-descending bypass.
    Author: Pethig K, Wahlers T, Tager S, Borst HG.
    Journal: Ann Thorac Surg; 1996 Jun; 61(6):1724-6. PubMed ID: 8651774.
    Abstract:
    BACKGROUND: In adult patients, the combination of severe aortic valve stenosis and coarctation is rare. Surgical options comprise either a two-stage approach with valve replacement and subsequent repair of the coarctation or a one-stage repair involving valve replacement and insertion of an extraanatomic bypass graft from the ascending to the descending aorta. METHODS: We report the cases of 2 adult patients with this combined lesion who underwent simultaneous aortic valve replacement and transpericardial bypass of the coarctation. RESULTS: Weaning from extracorporeal circulation and restoration of spontaneous circulation required resuscitative measures. By increasing mean arterial perfusion pressure using norepinephrine, the observed hemodynamic instability could be controlled effectively. CONCLUSIONS: Changes in the hemodynamics of the thoracic vascular bed resulting in coronary malperfusion are discussed to be the major cause of heart failure and life-threatening ventricular arrhythmias seen in our patients after aortic valve replacement and insertion of an ascending-descending aorta bypass graft. Awareness of the complications described is considered important for successful management of these high-risk patients.
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