A cardiothoracic surgery expert witness advises on a case involving an 80-year-old patient, located in Nebraska, who underwent an aortic valve replacement (Medtronic) that was met with some difficulty. The patient’s valve appeared to have a high gradient that was confirmed on a post operative cath lab evaluation. The patient returned to the OR and underwent removal of the first valve and an aortic root replacement with single vessel bypass grafting was performed. The patient’s recovery was met with significant coagulopathy and bleeding along with heart failure and generalized edema. The patient was sent to the ICU with an open chest and returned for a mediastinal washout with temporary dressing closure. Hepatorenal failure and multi-organ system failure ensued and life support was withdrawn after she developed massive acidosis which was thought to be link to an abdominal event.