Combined valve and coronary artery bypass grafting Quiz

A cardiologist refers a patient to you for aortic and mitral valve replacement and two vessel bypass –OM2 and RCA. You evaluate the patient and review his echocardiogram and find that he does need to have his aortic valve replaced but you feel confident of repairing his mitral valve. Upon reviewing his cath, you agree that he will need a two vessel bypass. You schedule him for surgery. On the day of surgery your operative strategy is:

A 55 year old man with a history of bioprosthetic aortic valve replacement presents with bioprosthetic valve stenosis, severe mitral stenosis and 80% proximal LAD disease. He is a surgical candidate and plan is for re-do sternotomy, AVR, MVR, and CABG x1. Which of the following is the best operative course?

How should the aortotomy for AVR be planned when performing concomitant AVR and CABG x3?

A patient underwent combined CABGx3 for NSTEMI, AVR and MVR, for combined aortic and mitral regurgitation. Cross clamp time was 3 hours, bypass time 3.5 hours, and both antegrade/retrograde cardioplegia was used.  At the conclusion of bypass, the biventricular function is moderately reduced with well functioning valves. Pressors are escalating. Which of the following best explains this outcome?

A 69-year-old male undergoes a left heart catheterization for worsening exertional chest pain and is found to have a 90% LAD lesion, 70% OM1 lesion, and 80% RCA lesion. A preoperative workup for CABG is initiated. On transthoracic
echocardiogram, he is found to have moderate mitral valve stenosis. Which of the following would NOT be an indication for mitral valve replacement concomitantly with a CABG?