Case 6

Retrosternal Thyroid

A 70 year old gentleman was admitted to undergo excision of a very large retrosternal thyroid. pre op assessment by the SHO discovered a murmur. Further investigation revealed that the patient had significant aortic stenosis and an aneurysm of the ascending aorta (7cm), and significant disease in his proximal LAD. He clearly needs thyroidectomy, AVR and ascending aortic replacement and CABG x 1. What order would you perform these procedures?

This patient needs a combined procedure.

Both procedures will make the other difficult secondary to adhesions, if performed sequentially. Performing a thyroidectomy, via a neck incision +/- median sternotomy  and under the same anesthetic then performing an AVR and ascending aortic replacement and CABG x 1 would probably be best.