Feasibility of hybrid off pump artery bypass grafting and transaortic transcatheter aortic valve implantation: A case series

Abstract

The hybrid off-pump CABG and transaortic TAVI procedure allows for more complete coronary revascularization, negates the need for DAPT, and minimizes treatment delay of a TAVI procedure, particularly in patients unsuitable for transfemoral access. We propose this as an important treatment option for the heart team to consider. © 2016 Wiley Periodicals, Inc.

Transcatheter aortic valve replacement- management of patients with significant coronary artery disease undergoing aortic valve interventions: surgical compared to catheter-based approaches in hybrid procedures

“…Guidelines now tentatively recommend this combination for severe AS patients with concomitant coronary stenosis occupying > 70% of the artery diameter [2]; however not all coronary lesions are treatable with PCI. More recently, off-pump CABG (OPCAB) has been proposed as a method of complete coronary revascularisation in patients with complex stenosis and/or high SYNTAX scores [5, 6], with the off-pump technique avoiding the harmful effects of cardiopulmonary-bypass (CPB) [7]. OPCAB has been used to treat multi-vessel disease requiring a larger operative area, with a recent 4-patient series outlining its successful use immediately prior to transaortic (TAo) TAVR [8].…”

Hybrid off‐pump coronary artery bypass grafting surgery and transaortic transcatheter aortic valve replacement: Literature review of a feasible bailout for patients with complex coronary anatomy and poor femoral access

“…Our patient, like four other cases presented in the literature had a severely calcific aorta, which is a traditional contraindication to surgical intervention. The presence of a porcelain aorta inhibits aortic cannulation, cross‐clamping of the ascending aorta, and partial clamping of the aorta to perform proximal anastomoses.…”

“…Hybrid off‐pump CABG and transaortic TAVR has been described in a limited number of case reports and small case series throughout the world . This treatment modality has proven a feasible alternative for patients with severe AS and complex multivessel coronary artery disease who are not candidates for conventional CABG and surgical aortic valve replacement (SAVR), or with other associated comorbidities that preclude them from the standard transfemoral TAVR approach and PCI.…”

“…Since the first successful case of a hybrid off‐pump multivessel CABG and transaortic TAVR from Iran was reported back in 2011, 17 other cases have been described in the literature . All patients had multiple comorbidities with elevated STS (range, 2.6‐25; 6%) and EuroScore I (range, 13.7‐83; 7%) and were not considered candidates for conventional CABG and SAVR.…”

Complete transcatheter versus complete surgical management for combined aortic stenosis and coronary artery disease: A false dichotomy?

“…While Sá et al report a long-term mortality benefit to total surgical management compared with total transcatheter management for patients with this pathology, it is important to note that the dichotomy between surgical and transcatheter approaches has begun to evaporate given the advent of hybrid approaches. In particular, reports of combined TAVI with off-pump CABG or minimally invasive direct CABG have generated some enthusiasm, [10][11][12][13][14] although concerns do still exist regarding their potentially increased in-hospital mortality compared with TAVI-PCI, along with their potentially higher in-hospital mortality, 12-month mortality, and rehospitalization rates when compared with SAVR-CABG. 15 Conversely, reports of staged minimally invasive valve surgery and PCI have also been published with promising results, [16][17][18][19] though this approach is limited through PCI's decreased efficacy with more complex coronary lesions.…”