Case report of a multidisciplinary approach to one-time treatment of a patient with critical aortic valve stenosis, lesion of the left main coronary artery and bleeding stomach cancer

Abstract

Aortic valve stenosis and bleeding gastric cancer are formidable diseases characterized by high mortality. For a long time, the gold standard for treating patients with aortic stenosis has been open-heart surgery — aortic valve replacement. However, the endovascular operation that appeared in 2002 — transcatheter aortic valve implantation (TAVI) has become the standard of care for patients with high surgical risk. Gastric cancer is one of the major severe oncological diseases in which surgery is the only way to cure. The combination of these two diseases significantly worsens the prognosis and is a difficult clinical task for choosing the optimal tactics for treating a patient. Given the lack of developed standards for the treatment of multimorbid patients, the treatment plan is determined by an interdisciplinary consultation. But with a combination of these diseases, there is no generally accepted approach in the known recommendations. The purpose of this report is to present a clinical case of a patient with critical aortic stenosis, concomitant severe coronary artery disease, and bleeding stomach cancer, who underwent a successful one-stage operation — percutaneous coronary intervention, TAVI and open gastrectomy with Roux-loop reconstruction with one anesthetic aid by the decision of a multidisciplinary team. The patient was discharged in a satisfactory condition. In the late follow-up period, angina pectoris returned with restenosis of the stent in the anterior interventricular branch (LAD), which required repeated intervention in the form of LAD restenting with a good clinical result. A hybrid approach in the treatment of patients with critical aortic valve stenosis in combination with coronary artery disease and bleeding gastric cancer can be accepted as one of the possible strategies, but further research is needed in this direction. Received 15 October 2021. Revised 20 January 2022. Accepted 31 January 2022. Informed consent: The patient’s informed consent to use the records for medical purposes is obtained. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Contribution of the authorsLiterature review: N.L. Irodova, L.G. GeletsyanDrafting the article: N.G. Karapetyan, N.N. MeleshenkoCritical revision of the article: B.G. Alekyan, A.Sh. RevishviliSurgical treatment: B.G. Alekyan, D.V. Ruchkin, N.G. Karapetyan, N.N. MeleshenkoFinal approval of the version to be published: B.G. Alekyan, D.V. Ruchkin, N.G. Karapetyan, N.L. Irodova, N.N. Meleshenko, L.G. Geletsyan, A.Sh. Revishvili