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Left Ventricular Apex Venting in High-Risk Redo Sternotomy With Severe Aortic Insufficiency: A Case Report

Wakefield, Brett, J., MD*; Leone, Alexander, J., MD*; Sale, Shiva, MD

doi: 10.1213/XAA.0000000000000623
Case Reports: Case Report

Redo cardiac surgery in patients with severe aortic insufficiency can present unique challenges to the anesthesiologist. We report a case highlighting the challenge and importance of interdisciplinary planning between cardiothoracic surgeons and anesthesiologists prior to high-risk surgery. Failure to place an endoaortic balloon and percutaneous coronary sinus catheter due to anatomical abnormalities prompted the adoption of an alternate technique involving apical ventricular venting to assist sternal reentry. Apical left ventricular venting was successfully used to prevent ventricular dilation and dysfunction during institution of cardiopulmonary bypass with significant aortic regurgitation and hypothermia-induced ventricular fibrillation.

From the Departments of *Anesthesiology and Cardiothoracic Anesthesiology, Cleveland Clinic, Cleveland, Ohio.

Accepted for publication July 12, 2017.

Funding: None.

The authors declare no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website.

Address correspondence to Brett J. Wakefield, MD, Department of Anesthesiology, Cleveland Clinic, 9500 Euclid Ave, E30-R, Cleveland, OH 44195. Address e-mail to

© 2018 International Anesthesia Research Society
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