Apico-Biaxillary Bypass for an Aortic Stenosis Patient With Severe Calcification of the Entire Aorta

Abstract

A 70-year-old man with severe aortic stenosis was referred with repeated hospitalization for congestive heart failure for 1 year and a 1-month history of serious hypotension during every hemodialysis. He had been treated for diabetes mellitus for 28 years and had been undergoing hemodialysis for 5 years. Medical history included iliac and femoral arterial atherosclerosis treated with catheter and surgical interventions. Transthoracic echocardiography showed elevation of the systolic aortic transvalvular gradient (peak gradient, 67 mm Hg; mean gradient, 42 mm Hg), aortic valve area of 0.8 cm2 measured by the continuity equation, and mild aortic regurgitation (Figure 1, Movie I in the online-only Data Supplement). Coronary angiography demonstrated 75% stenosis of the left anterior descending artery. Computed tomography revealed severe calcification of arterial system, particularly of the entire aorta, except for the bilateral axillary arteries (Figure 2). Conventional aortic valve replacement was regarded as a difficult procedure because of the necessity for aortic cannulation, aortic cross-clamp, and aortotomy. Figure 1. A, Transthoracic echocardiography showing a thick calcified aortic valve with reduced opening (arrow; see Movie I in the online-only Data Supplement). B, Continuous wave Doppler recording of aortic velocity from the apex with a peak systolic aortic transvalvular gradient of …