Japanese Journal of Cardiovascular Surgery Vol.50, No.2

Apico-Aortic and Biaxillary Bypass for Severe Aortic Stenosis
Kenji Yoshida* Hideo Yoshida* Yoshimasa Kishi*
Yuto Narumiya* Shohei Yokoyama* Munehiro Saiki*
Atsushi Tateishi* Yu Ohshima* Keiji Yunoki*
Kunikazu Hisamochi*

(Department of Cardiovascular Surgery, Hiroshima City Hiroshima Citizens Hospital*, Hiroshima, Japan)

A 75-year-old man who had maintenance hemodialysis for diabetic end-stage renal disease and had a history of coronary artery bypass grafting for angina pectoris was getting out of breath. Transthoracic echocardiography showed severe aortic stenosis(aortic transvalvular peak velocity(V):4.1m/s, aortic valve area:0.57cm2, LV ejection fraction(EF):35%). Computed tomography images showed severe calcification of the ascending aorta, and the patent right internal thoracic artery(RITA)graft crossed just the rear of sternum. Conventional aortic valve replacement(AVR)was regarded as a difficult procedure because of the risk of injuring RITA by re-sternotomy, and the necessity for aortic cross-clamp and aortotomy. In addition, he could not have transcatheter aortic valve implantation(TAVI)because TAVI is not indicated for hemodialysis patients in Japan. Instead of AVR and TAVI, the apico-aortic bypass technique was applied. A Y-shaped artificial graft was used for the distal side of the valved conduit, and the distal portions were anastomosed to the descending aorta and axillary-axillary bypass graft which was instituted in advance for one of inflow of cardiopulmonary bypass. Finally, apico-aortic and biaxillary bypass was performed and it successfully decreased the peak V across the native aortic valve from 4.1 to 2.9m/s and increased LVEF from 35 to 46%. In addition, a peak V across bioprosthetic valve was 1.6m/s.


Jpn. J. Cardiovasc. Surg. 50:78-81(2021)

Keywords:apico-aortic bypass;aortic stenosis(AS);transcatheter aortic valve implantation(TAVI);hemodialysis(HD)

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