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Coronary ostial enlargement to prevent stenosis after prosthetic aortic valve replacement

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Abstract

Iatrogenic left and/or right coronary artery ostial stenosis after aortic valve replacement is a rare but life-threatening complication. Although usually related to trauma to the ostium/a during cannulation for administration of cardioplegia, it may be rarely due to direct obstruction by the prosthetic annular ring or stent. We report herein an alternative technique to manage this complication when due to the latter event, successfully utilized at our institution over the last eleven years.

Section snippets

Technique

Out of more than 1800 aortic valve replacements performed at the Division of Cardiac Surgery of the University of Verona since 1992, three patients (< 0.2%), 2 male and 1 female, with a mean age of 66.6 years, operated upon for aortic stenosis, showed the abovementioned intraoperative complication.

In all cases, after the mechanical prosthesis was tied down in its final position, the coronary ostia (both in two cases; left main alone in one) appeared partially occluded by the device (Fig 1A).

Comment

Coronary ostia stenosis after aortic valve replacement determined by the device is a dreadful complication with a high mortality rate if left untreated 1, 2, 3, 4, 5, 6. Prompt recognition of the problem is mandatory and usually implies device removal and/or re-replacement with a smaller valve size with or without annular enlargement. This approach may be difficult, particularly in patients with small aortic root, and result in a very long ischemia time with possible subsequent myocardial

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