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.
The authors declare no conflicts of interest.
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Address correspondence to Brett J. Wakefield, MD, Department of Anesthesiology, Cleveland Clinic, 9500 Euclid Ave, E30-R, Cleveland, OH 44195. Address e-mail to email@example.com.