Trans catheter Aortic Valve Implantation after previous coronary artery bypass surgery

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Submitted by Dr T on December 20, 2012 – 10:20am

Question: 
I have been diagnosed with aortic valve stenosis moderate to severe and tricuspid valve severe. I had some complications with CABG 4 yrs ago.  At my age (77) would I possibly be a candidate for TAVI or MIS valve repair?  Tks. 

Trans-catheter Aortic-Valve Implantation (TAVI) is a relatively new procedure that is used primarily for patients who are not a candidate for traditional valve replacement and will not address your tricuspid valve problems. Minimally Invasive Surgery (MIS) is probably not an option in most re-operations such as previous coronary artery bypass surgery, especially if other procedures (such as another valve operation) are needed.

Thus, the first question to ask your cardiologists/surgeons is whether fixing your aortic valve alone will be sufficient treatment. If so, TAVI might be a solution for you. However, if both valves need to be replaced, it is much more likely this can only be done with a traditional operation – frankly, my inclination at this point (depending on your heart function, the presence of residual coronary artery disease and your overall condition).

When still practicing as a cardiac surgeon I occasionally faced difficult situations such as this, and I highly recommend you talk to an experienced cardiac surgeon as well as your cardiologist before making a final decision.
Hope this helps,
Dr T

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