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Early Reoperation for Iatrogenic Left Main Stenosis after Aortic Valve Replacement: A Perilous Situation

Background. Iatrogenic left main coronary artery (LMCA) stenosis secondary to direct ostial cannulation during aortic valve replacement still occurs and is a morbid situation due to the difficulties of early reoperation and in providing adequate myocardial protection. Methods. A retrospective analysis was performed and identified seven patients with an iatrogenic LMCA stenosis, after 2158 aortic valve replacements (AVR) (0.3%) in our institution since 1987. Results. All patients with LMCA stenosis after AVR had undergone direct ostial cannulation with self-inflating balloon cannulas at the time of AVR. At reoperation for LMCA stenosis, severe ischemia developed in one patient and injury to cardiac structures occurred in four patients. Four patients suffered a perioperative myocardial infarction and congestive heart failure developed in two patients at late follow-up. Conclusions. LMCA stenosis following coronary ostial cannulation at the time of AVR is a rare yet morbid complication. Reoperation for this condition is fraught with a high operative morbidity rate and poor long-term outcome. Prevention of this complication is quintessential, avoiding ostial cannulation with self-inflating balloons.