Vol. 20 JA2016 - cardiac

C-02 – Is TAVI becoming the treatment of choice in patients undergoing aortic valve replacement with previous patent IMA?

novembre 29, 2016
Auteur correspondant : Georges Teddy

Georges Tedy, Paul Karam, Violette Karam, Patricia Nehme, Paul Naser

Institution : hôpital Mont Liban, Beyrouth, Liban

Objectives : Transcatheter aortic valve replacement (TAVR) has been shown to be successful in high risk patients . redo-aortic valve surgery (redo-AVR) in patients with previous coronary artery bypass grafting (CABG) and patent grafts carries a high mortality. To define the best treatment strategy for this cohort of patients, we reviewed our experience with redo-AVR.

Methods : From January 2010 to December 2015, 35 consecutive patients underwent  redo-AVR at our Insitution. A peripheral femoro-femoral bypass had been installed to all patients prior to the sternotomy. 3 injuries of the IMA grafts had been noted and provoqued a recuperable Ventricular fibrillation, 2 injuries of the right ventricule and 2 of the inominate vein which precipitate a partial departure of bypass to allowed a correct surgical repair.

Results : The 30-day mortality was 8.5%, and the incidence of debilitating strokes (3%), sepsis (6%). Following the procedure, the mean CSU stay was 3 days and the total in hospital stay of 7 days. The range of mortality in the literature is between 7% and 20%.

Conclusion : Our results show that conventional AVR as a redo procedure after CABG even in case of both patent IMA grafts can be performed with excellent results and a lower mortality than estimated, thanks to the use of an adapted surgical strategy.