Abstract
Redo cardiac surgery represents a clinical challenge due to a higher rate of perioperative morbidity and mortality. Mitral valve (MV) reoperations can particularly be demanding in patients with patent coronary grafts, previous aortic valve replacement, calcified aorta or complications following a previous operation. In this article we describe technique to manage systemic hyperkalemia in 68-year-old man who underwent bioprosthetic mitral valve replacement, already undergone coronary artery bypass grafting 13 years, come in our clinic to aggravated dyspnea caused by severe stenosis of the mitral valve. Because cross-clamping would have a high risk of stroke owing to severe calcification of the ascending aorta systemic hyperkalemia and continuous blood perfusion can guarantee adequate myocardial protection particularly in the case of patent grafts, decreasing potential lesions due to demanding clamp placing.
Highlights
Aortic cross-clamping in patients with porcelain aorta is associated with high mortality and morbidity rates
We show an alternative technique in a porcelain aorta patient with myocardial revascularization, without the aortic manipulation, use of hypothermia and ventricular fibrillation, through systemic hyperkalemia
The patient was a candidate for mitral valve replacement surgery with a Euroscore II 2.5%, and underwent a Mini-Mental State Examination, before the procedure he reported an index of 28, an expression of cognitive normality [2]
Summary
Aortic cross-clamping in patients with porcelain aorta is associated with high mortality and morbidity rates. In this case report, we show an alternative technique in a porcelain aorta patient with myocardial revascularization, without the aortic manipulation , use of hypothermia and ventricular fibrillation, through systemic hyperkalemia. Scan before surgery (Figure 1, Figure 2) [1]. Have not been found hemodynamically significant carotid stenosis. Preoperative blood count values without significant alterations (Hemoglobin 11.5 g/ dl, Creatinine 1.10 mg/dl). The patient was a candidate for mitral valve replacement surgery with a Euroscore II 2.5%, and underwent a Mini-Mental State Examination, before the procedure he reported an index of 28, an expression of cognitive normality [2]
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