Emergent Redo BioBentall at the Height of COVID-19
Jeffrey Jiang, Kazuhiro Hisamoto
New York University, New York, NY, USA
OBJECTIVE: The SAR-COV19 (covid-19) pandemic resulted in cancelled elective surgeries and limited operations to preserve intensive care resources. We present the case of a 54-year old man presenting with an infected prosthetic aortic valve and root replacement complicated by a contained rupture. He was positive for covid-19 on presentation despite being asymptomatic and recovered successfully after surgery.
METHODS: The patient went for emergent repair. Cannulation strategy consisted of axillary arterial and femoral venous cannulation. Sternotomy with oscillating saw resulted in entry into the contained rupture and initiation of bypass. Dissection revealed a complete dehiscence of the previous composite graft. The distal aorta was cross-clamped and the heart arrested. The graft was excised, coronary buttons detached, and the annulus de-brided. The annulus was reconstructed with bovine pericardium and a 25 mm Magna-Ease aortic valve and 30mm Gelweave Valsalva graft were implanted. Coronary buttons were re-implanted and distal anastomosis completed under a single clamp.
RESULTS: Post-operative course was complicated by re-intubation and tracheostomy and gastrostomy tube placement for de-conditioning. The patient never developed infiltrates or ARDS despite persistent positive covid-19 tests. He was eventually weaned from the ventilator and de-cannulated before discharge. None of the peri-operative team tested positive for covid-19 in the postoperative period.
CONCLUSIONS: Decision making in the era of covid-19 is highlighted by unknown risks to the patient from a novel disease course as well as risks to the operating team from spread of virus. We report the successful recovery of a covid-19 positive patient undergoing complex cardiac surgery.
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