Associazione Nazionale Medici Cardiologi Ospedalieri



The “Back to the Future” of Cardiothoracic Surgery: High-risk interventional procedure turned down to conventional cardiac surgery

Totaro Pasquale Pavia(Pavia) – SC Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo | Aiello Marco Luigi Pavia(Pavia) – SC Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo | Pelenghi Stefano Pavia(Pavia) – SC Cardiochirurgia, IRCCS Fondazione Policlinico San Matteo


Structural interventional cardiology has been introduced at the beginning of our century to address high-risk patient suffering from severe aortic stenosis. Since then several technique and technology have been proposed to address an increasing population of patients and mitral valve diseases have been also addressed. While several authors are pushing up the indications for structural interventional procedures, however, we are experiencing some situations were conventional surgery is considered an alternative to high risk interventional procedures. Here we present a peculiar case of “back to the future” in cardiothoracic surgery.

Case description

A 76 yo female patient, was referred to our Division from a peripheral Hospital suffering from severe aortic stenosis and coronary artery diseases. Medical history of the patient included persistent AF, COPD, arterial peripheral vascular disease, moderate chronic renal insufficiency and moderate dilatation of ascending aorta. Patient was previously assessed by another Centre and a percutaneous treatment (PTCA+TAVI) was proposed. Due to further admission for cardiac failure-related symptoms, however, patient was urgently referred to our Division. Fig 1 and 2 summarized clinical findings. “Heart team” evaluation, based also on the product specialist evaluation, considered the patient not suitable for interventional procedure due to the high risk of sub-optimal medium-term prognosis. Due to further clinical deterioration an extremely high-risk surgical procedure was mandatory.


Surgical procedure included a sutureless aortic valve replacement, a MV plasty, a double coronary graft + a cpmbined carotid endoarterectomy. Postoperative course was free from significant complications and the patient was discharged to rehabilitation clinic on 15th postoperative days.


Despite interventional procedure are continuing to increase either as number of procedure either as complexity of diseases treated, conventional cardiac surgery remains still the only option for treatment in many clinical scenario. As a sort of “back to the future” situation, patient originally referred for interventional procedures are turned down due to the high risk of sub-optimal results. In such condition conventional cardiac surgery, performed with high level of accuracy could represent the last and only treatment option for high risk patients.