Complex surgical treatment of critical aortic stenosis complicated by multiple organ failure

Bicuspid aortic valve occurs in 0.5-2% of population and leads to accelerated leaflet calcification, early stenosis and severe heart failure in young patients. NT-proBNP is a biomarker of decompensation and independent predictor of poor prognosis: its elevation above 5000 pg/ml is associated with high mortality risk. Balloon valvuloplasty is used as a palliative measure and a bridge to radical treatment in patients with high surgical risk. This procedure allows not only to reduce surgical risk by 30-40% but also to transfer the patient from inoperable category to extremely high-risk group. This article presents comprehensive treatment of a 35-year-old patient with critical aortic stenosis complicated by severe heart failure and multiple organ failure. Due to decompensation of chronic heart failure and signs of liver cytolysis, a staged approach was employed. The first stage involved palliative balloon valvuloplasty that was complicated by cardiac arrest with successful cardiopulmonary resuscitation. Eight days later, radical treatment was performed: ascending aortic and aortic valve replacement, thrombectomy from the left ventricle and DeVega tricuspid valve annuloplasty. The patient was discharged. This strategy demonstrated safety and efficacy in a patient with critical aortic stenosis and multiple organ failure, as well as feasibility of radical surgical treatment in patients with high surgical risk.