A Case of Massive Bleeding from Esophageal Varices during Off-pump Coronary Artery Bypass Surgery and Transcatheter Aortic Valve Implantation

Abstract

A case of massive bleeding from esophageal varices during transcatheter aortic valve implantation (TAVI) is reported along with a literature review.
An 83-year-old man with type C hepatic cirrhosis was diagnosed with aortic valve stenosis (AS) three years prior. He was admitted to the hospital due to exertional dyspnea and was diagnosed with severe AS and coronary artery stenosis. Owing to his comorbidities, concomitant TAVI and off-pump coronary artery bypass grafting (OPCAB) were performed. During OPCAB, massive bleeding occurred in the oral cavity. He had been diagnosed with esophageal varices before surgery, and the bleeding was considered to be associated with the esophageal varices. Emergency gastrointestinal endoscopy was performed after the completion of both surgical procedures, and oozing-like bleeding from the esophageal varices was seen. Endoscopic esophageal varices ligation was performed to stop the bleeding.