Transcatheter aortic valve implantation and off-pump coronary artery bypass surgery: an effective hybrid procedure in selected patients†

Mayr, Benedikt; Firschke, Christian; Erlebach, Magdalena; Bleiziffer, Sabine; Krane, Markus; Herold, Ulf; Nöbauer, Christian; Lange, Rüdiger; Deutsch, Marcus-André

doi:10.1093/icvts/ivy014

Cited by 12 publications

(6 citation statements)

References 21 publications

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“…Several studies described the concomitant TAVI procedure and OPCAB coronary revascularization and reported the similar 30‐day mortality as in our cohort 22,29,30 . In our study we observed 10% 30‐day mortality.…”

Section: Discussionsupporting

confidence: 86%

Simultaneous transaortic transcatheter aortic valve implantation and off‐pump coronary artery bypass: An effective hybrid approach

et al. 2021

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Introduction Transcatheter aortic valve implantation (TAVI) techniques are increasingly being adopted into clinical routine for various risk groups. Coronary artery disease (CAD) is seen in up to 75% of patients with severe aortic valve stenosis (AS) presenting with typical angina pectoris. Due to high mortality rates and procedural complications in these patients, a hybrid concept of simultaneous transaortic TAVI and off‐pump coronary artery bypass (OPCAB) can be a feasible treatment option. Methods Between April 2014 and July 2020, 10 consecutive high‐risk patients underwent concomitant transaortic TAVI and OPCAB at our institution. All indications were discussed in Heart Team and decisions were made based on patients' comorbidities and complexity of CAD. The study endpoints were 30‐day mortality, device success, and development of postoperative adverse events defined by the Valve Academic Research Consorium. Results The mean age of the patients was 77.9 ± 7.1 years old. All patients presented with multiple comorbidities (mean logistic EuroSCORE 26.5 ± 12.3%, median EuroSCORE II 5.13% [interquartile range 4.2–9.5], mean STS‐Score 6.04 ± 1.6%). Five patients (50%) presented with porcelain aorta. No conversion to conventional procedures was needed. 30‐day mortality occurred in one patient (10%). Complete revascularization was achieved in seven (70%) of the patients. Device success rate was 100%. No paravalvular leakage was detected. No stroke, myocardial infarction or vascular complications were observed. Conclusions A hybrid approach combining transaortic TAVI and OPCAB might be a safe and feasible method of treatment in high‐risk patients presenting with severe AS and CAD who are not eligible for conventional surgical or interventional solutions.

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Section: Discussionsupporting

confidence: 86%

Simultaneous transaortic transcatheter aortic valve implantation and off‐pump coronary artery bypass: An effective hybrid approach

et al. 2021

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“…This worrying in-hospital mortality rate for TAVI + OP/MIDCAB patients (18%) was likely due to the fact these patients were sicker and older compared to the SAVR + CABG ones; this procedure is more invasive than percutaneous treatments and probably requires a steeper learning curve. This mortality rate is comparable to the one previously reported for this particular hybrid procedure in a comparable patient population [70] , but in another population of fewer patients there were no in-hospital deaths [71] . This difference is probably in relation with the patient condition and the surgeon's skills.…”

Section: Hybrid Approachessupporting

confidence: 83%

Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Aurigemma¹,

Romagnoli²,

Bianchini³

et al. 2022

MIS

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Severe calcific aortic stenosis (AS) and coronary artery disease (CAD) have common risk factors and are frequently encountered in the same patient in clinical practice. CAD has been reported in ≥ 50% of AS patients undergoing both surgical treatment and transcatheter aortic valve implantation (TAVI). In the last two decades, TAVI has been established as a less invasive alternative to surgery. Recently, more and more young and low surgical risk patients undergo TAVI. Despite the high prevalence of CAD in patients treated with TAVI, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty. This review provides an updated overview of the current knowledge about this topic and offers points for reflection about the best approach to use.

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Section: Discussionmentioning

confidence: 68%

“…Combined OPCAB and TAVR have been described in previous studies, however, aortic manipulation was involved in each one due to transaortic TAVR placement or proximal anastomoses in at least a subset of patients. [18][19][20][21] Our case series is the first to describe an entirely anaortic OPCAB combined with a transfemoral TAVR procedure. We have shown excellent results with device success achieved with no paravalvular leak on TEE in 100% of our cohort and complete revascularization achieved in 100% of patients.…”

Section: Stroke and Anaortic Techniquementioning

confidence: 87%

Concomitant anaortic OPCAB and transfemoral TAVR for high‐risk patients: A case series

Vallely

Vijayakumar

Whitson

et al. 2022

Journal of Cardiac Surgery

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Background Combined on‐pump coronary artery bypass (ONCAB) and surgical aortic valve replacement (SAVR) is the treatment of choice for concomitant severe aortic stenosis and coronary artery disease not amenable to percutaneous coronary intervention. Extensive aortic calcification and atheromatous disease may prohibit cardiopulmonary bypass and aortic cross‐clamping. In these cases, anaortic off‐pump coronary artery bypass (OPCAB) is a Class I (EACTS 2018) and Class IIA (AHA 2021) indication for surgical coronary revascularization. Transcatheter aortic valve replacement (TAVR) has similar benefits when compared with SAVR for this population (Partner 2 & 3). Herewith we describe a case series of concomitant Anaortic OPCAB and TAVR via the transfemoral approach for patients with coronary artery and valve disease considered too high risk for traditional coronary artery bypass grafting and SAVR due to severe aortic disease. Methods/Results Eight patients underwent anaortic OPCAB and transfemoral TAVR during the same anesthetic in a hybrid operating room. Seven patients with multivessel disease had anaortic OPCAB via a sternotomy using composite grafts, one patient with LAD disease had anaortic OPCAB using a Da Vinci‐assisted MIDCAB approach. All patients then had an Edwards Sapien 3 TAVR placed percutaneously via the common femoral artery. There was no 30 mortality or CVA in the series and all patients were discharged to home or a rehabilitation facility on Day 4–13. Conclusions Combined anaortic OPCAB and transfemoral TAVR is a safe and feasible approach to treating concomitant extensive coronary artery disease and severe aortic stenosis. The aortic no‐touch technique provides benefits in the elderly high‐risk patients by reducing the risk of postoperative myocardial infarction and cerebrovascular stroke.

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Transcatheter aortic valve implantation and off-pump coronary artery bypass surgery: an effective hybrid procedure in selected patients†

Abstract: Hybrid OPCAB/MIDCAB and TAVI prove to be a safe and effective alternative treatment option in selected higher risk patients.

Cited by 12 publications

References 21 publications

Simultaneous transaortic transcatheter aortic valve implantation and off‐pump coronary artery bypass: An effective hybrid approach

Simultaneous transaortic transcatheter aortic valve implantation and off‐pump coronary artery bypass: An effective hybrid approach

Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Concomitant anaortic OPCAB and transfemoral TAVR for high‐risk patients: A case series

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