Perioperative complications in combined aortic valve replacement and extraanatomic ascending-descending bypass

Ann Thorac Surg. 1996 Jun;61(6):1724-6. doi: 10.1016/0003-4975(96)00140-3.


Background: In adult patients, the combination of severe aortic valve stenosis and coarctation is rare. Surgical options comprise either a two-stage approach with valve replacement and subsequent repair of the coarctation or a one-stage repair involving valve replacement and insertion of an extraanatomic bypass graft from the ascending to the descending aorta.

Methods: We report the cases of 2 adult patients with this combined lesion who underwent simultaneous aortic valve replacement and transpericardial bypass of the coarctation.

Results: Weaning from extracorporeal circulation and restoration of spontaneous circulation required resuscitative measures. By increasing mean arterial perfusion pressure using norepinephrine, the observed hemodynamic instability could be controlled effectively.

Conclusions: Changes in the hemodynamics of the thoracic vascular bed resulting in coronary malperfusion are discussed to be the major cause of heart failure and life-threatening ventricular arrhythmias seen in our patients after aortic valve replacement and insertion of an ascending-descending aorta bypass graft. Awareness of the complications described is considered important for successful management of these high-risk patients.

Publication types

  • Case Reports

MeSH terms

  • Amiodarone / therapeutic use
  • Anti-Arrhythmia Agents / therapeutic use
  • Aorta / surgery
  • Aorta, Thoracic / surgery
  • Aortic Coarctation / complications
  • Aortic Coarctation / surgery*
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / complications
  • Aortic Valve Stenosis / surgery*
  • Blood Pressure / drug effects
  • Blood Vessel Prosthesis*
  • Cardiac Output, Low / drug therapy
  • Coronary Circulation / drug effects
  • Extracorporeal Circulation
  • Female
  • Heart Valve Prosthesis*
  • Humans
  • Hypotension / drug therapy
  • Intraoperative Complications*
  • Male
  • Middle Aged
  • Norepinephrine / therapeutic use
  • Pericardium / surgery
  • Vasoconstrictor Agents / therapeutic use
  • Ventricular Fibrillation / drug therapy


  • Anti-Arrhythmia Agents
  • Vasoconstrictor Agents
  • Amiodarone
  • Norepinephrine