MULTIDISCIPLINARY APPROACH TO TREATMENT OF PATIENT WITH BIOPROSTHETIC AORTIC VALVE DYSFUNCTION AND RENAL CELL CARCINOMA WITH TUMOR THROMBUS

Highlights

This review presents a clinical case of a patient with a rare combination of two life-threatening pathologies whose treatment required high-tech surgery. The effectiveness of a multidisciplinary approach to treatment has been demonstrated.

Annotation

Aortic stenosis (AS) is the most common heart disease in elderly patients requiring treatment. Malignant neoplasms of the kidneys account for about 3% of all cancers in the Russian Federation, and the formation of tumor thrombi in the renal and inferior vena cava occurs in 4–10% of patients with this pathology. Given the prevalence of aortic stenosis and renal cell carcinoma (RCC), the number of patients with a combination of these two conditions keeps increasing and they are recommended to undergo surgical treatment at multidisciplinary clinical centers. Transcatheter aortic valve implantation (TAVI) and radical nephrectomy with intracorporeal thrombectomy using the DaVinci Si robotic surgical system may be a preferred approach for the treatment of critical AS and RCC for this category of patients.

At the multidisciplinary clinical center a patient with dysfunctional bioprosthetic aortic valve implanted in 2010 and NYHA class 3 heart failure with history of endovascular treatment of coronary artery disease, peripheral arterial disease and carotid endarterectomy and concomitant renal cell carcinoma with tumor thrombosis of the renal vein received surgical treatment in 2 stages: TAVI – the first stage, and robot-assisted right-sided nephrectomy and thrombectomy from the renal vein – the second stage. The patient was discharged from the Center on the 7^th day after TAVI and on the 6^th day after surgery for renal cancer. Six months after the procedure, there was a decrease in the functional class of heart failure, satisfactory function of the transcatheter aortic valve bioprosthesis, decrease in the size of the left ventricle, decrease in the brain natriuretic peptide, and the absence of cancer progression.

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