Off-pump aortic valve bypass: an alternative technique for treating severe aortic stenosis

Abstract

Summary Nowadays, the majority of patients suffering from aortic valve stenosis are treated by aortic valve replacement (AVR) or via Transcatheter Aortic Valve Implantation (TAVI). However, there is a subset of patients having severe comorbidities that either potentiate periprocedural risk or impede above-mentioned treatment: renal insufficiency, severely impaired ejection fraction, bicuspid aortic valve, large aortic annulus, ostial encroachment, redo-operation as well as severely calcified (“Porcelain”) aorta. Aortic Valve Bypass (AVB) with placement of a valved fabric graft between left apex and descending aorta is considered to be an alternative treatment for this patient cohort. Though already developed in the early 1960’s general surgical acceptance was low due to the lack of appropriate instruments and the need for Cardio Pulmonary Bypass (CPB). However, with the development of a gun-like coring device (Correx, Inc., Waltham, MA, USA) these impediments have been overcome. We report on a 72-year-old male patient suffering from aortic valve stenosis with concomitant mutilating diagnoses who was rejected for conventional surgery and transcatheter treatment. Perioperative course with implantation of the AVB between left ventricular apex and the descending thoracic aorta without CPB was uneventful as was the postoperative course. The patient could be released from the hospital in good condition on day 15.