Aortic Valve Replacement Using Balloon Catheter for Thoracic Endovascular Aortic Repair to Patient with Calcified Aorta
A 79-year-old man was admitted due to severe chest pain and dyspnea for 3 days. The patient's medical history showed that he had undergone treatment for sustained ventricular tachycardia six years ago. The patient had been taking hypertension medicine.\nDuring the evaluation, the patient complained of mild chest pain. Preoperative chest radiography showed cardiomegaly and aortic arch calcification (). Electrocardiography showed a normal sinus rhythm. Echocardiography showed an ejection fraction of 31%, severe aortic valve stenosis (V max=5.26 m/sec, mean pressure gradient [PG]=69.4 mmHg, aortic valve area by continuity equation=0.6 cm2) and mild to moderate mitral valve regurgitation (proximal isovelocity surface area radius=0.7 cm). Coronary angiography showed no significant coronary artery disease, while chest computed tomography showed calcification of the posterior wall of the ascending aorta (). The patient underwent surgery under general anesthesia via median sternotomy. After pericardiotomy, arterial cannulation was accomplished in the right axillary artery.\nVenous drainage was accomplished with a single double-staged cavoatrial cannula. A vent cannula was inserted into the left ventricle via the right superior pulmonary vein. A root cannula was inserted into the ascending aorta. A thoracic endovascular aortic repair (TEVAR) balloon catheter (40×30 mm) for endo-aortic occlusion was inserted into the ascending aorta via the left superficial femoral artery using a C-arm (GE, Bayern, Germany) (). After initiation of cardiopulmonary bypass (CPB) with moderate hypothermia, endo-aortic occlusion was accomplished by inflation of the TEVAR balloon (). Blood cardioplegia solution was administered to arrest the heart via root cannula, and then this solution was administered via direct cardioplegia cannula every 20 minutes. Aortic valve replacement was performed with valve tissue. Termination of CPB was performed without complication.\nThe patient was extubated on the first postoperative day. Follow-up echocardiography showed an ejection fraction of 33%, a well-functioning aortic prosthetic valve (mean PG=22.4 mmHg) and minimal mitral valve regurgitation. The patient recovered without complication and was discharged on the eleventh postoperative day.