Totally Endoscopic Minimally Invasive Aortic Valve Replacement Under Near Normothermia in a Patient With Cryoglobulinemia.

Cardiac surgery in patients with cryoglobulinemia remains challenging because perioperative hypothermia may increase the risk of cryoglobulin-related complications. We report the case of a 49-year-old man with severe bicuspid aortic valve stenosis and preoperatively confirmed cryoglobulinemia who underwent totally endoscopic minimally invasive aortic valve replacement without preoperative plasmapheresis. The patient had no clinical manifestations of cryoglobulinemic vasculitis, and extensive hematologic and immunologic evaluation demonstrated no monoclonal gammopathy, a normal serum free light chain ratio, and negative viral and autoimmune markers. Because the patient was considered low risk for cryoglobulin-related complications, surgery was successfully performed using normothermic cardiopulmonary bypass with intermittent tepid blood cardioplegia, while maintaining a lowest core temperature of 34.8 °C. The postoperative course was uneventful, with no evidence of cryoglobulin-related complications. This case suggests that, in carefully selected low-risk patients without active vasculitic manifestations, minimally invasive cardiac surgery under strict normothermic management may be feasible without routine preoperative plasmapheresis.