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Coronary Ostial compromise in Aortic Valve Replacement: a rare but avoidable fatal complication
Shakil Farid, Aravinda Page, Neil Howell, Yasir Abu-Omar, Martin Goddard, David Jenkins, Samer Nashef.
Papworth Hospital, Papworth, United Kingdom.

Objective To determine the incidence and mechanism of surgical compromise of the coronary ostia in aortic valve replacement (AVR). Methods Retrospective review of prospectively collected clinical data and autopsy findings in 322 patients who died in hospital after AVR with or without concomitant procedures in a single institution from January 1998 to March 2013. Results Over the 15-year period, more than 17 surgeons performed 7507 AVRs with or without other procedures. The mean age was 70.8(±11.78) years and 63% were male. Bioprosthetic valves were used in 75% of cases, mechanical valves in 24.7% and homografts in only 0.3%. Early mortality for all patients (including combined, emergency and redo procedures) was 4.28% (mean logistic EuroSCORE 10.7). There were 322 deaths after procedures involving the aortic valve. Autopsy examination was carried out in all patients and showed that 3.4% (n=11) of deaths were at least in part attributed to encroachment on one or both of the coronary ostia. Causes of ostial compromise included the valve sutures, the valve sewing ring and the aortotomy suture line. Conclusion Coronary ostial compromise in AVR is a very rare but real problem occurring in at least 0.14% of AVRs and contributing to or directly causing one in every 29 AVR deaths. Surgeons should have a high level of awareness of the risk of this rare but fatal and avoidable complication.  

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