Premium
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
Author(s) -
Baquero Giselle A.,
Azarrafiy Ryan,
Marchena Eduardo J.,
Carrillo Roger G.
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14082
Subject(s) - medicine , revascularization , cardiology , valve replacement , percutaneous , coronary artery disease , stenosis , percutaneous coronary intervention , cardiac catheterization , euroscore , population , aortic valve replacement , surgery , artery , myocardial infarction , environmental health
Abstract Background and Aim of Study The treatment of inoperable patients with concomitant complex coronary artery disease and severe aortic stenosis unsuitable for conventional transcatheter aortic valve replacement (TAVR) poses a significant challenge. Effective treatment is even more difficult in those patients with complex coronary anatomy unamenable to percutaneous revascularization. Our manuscript aims to enlighten clinicians on the management of this complex patient. Methods We conducted a contemporary review of the literature of combined off‐pump coronary artery bypass grafting and transaortic TAVR in this patient population and describe our own successful experience in an inoperable patient with a porcelain aorta. Results Including our report, 17 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. Most had severe, complex, multivessel CAD deemed unsuitable for PCI and structural findings precluding them from other standard percutaneous or alternative TAVR approaches (transfemoral/subclavian/transcaval/transapical). Out of the 17 cases, 5 (29%) had porcelain aortas. Most reports specify the decision‐making process is driven by a multidisciplinary team. Conclusion This report demonstrates that hybrid off‐pump CABG surgery and transaortic TAVR can be successfully performed in high‐risk patients with porcelain aortas who are not candidates for percutaneous methods, on‐pump revascularization, transfemoral, subclavian, or transcaval valve implantations. It also highlights that careful study of the CTA scan could predict adequate access for a transaortic approach even in the presence of porcelain aorta in selected patients.