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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 591-597 |
| Number of pages | 7 |
| Journal | Journal of cardiac surgery |
| Volume | 34 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 1 2019 |
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Keywords
- coronary artery bypass grafting
- coronary artery disease
- hybrid
- off-pump
- transaortic
- transcatheter aortic valve replacement
ASJC Scopus subject areas
- Surgery
- Pulmonary and Respiratory Medicine
- Cardiology and Cardiovascular Medicine
Cite this
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. / Baquero, Giselle A.; Azarrafiy, Ryan; De Marchena, Eduardo; Carrillo, Roger G.
In: Journal of cardiac surgery, Vol. 34, No. 7, 01.07.2019, p. 591-597.Research output: Contribution to journal › Review article
}
TY - JOUR
T1 - Hybrid off-pump coronary artery bypass grafting surgery and transaortic transcatheter aortic valve replacement
T2 - Literature review of a feasible bailout for patients with complex coronary anatomy and poor femoral access
AU - Baquero, Giselle A.
AU - Azarrafiy, Ryan
AU - De Marchena, Eduardo
AU - Carrillo, Roger G.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - 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.
AB - 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.
KW - coronary artery bypass grafting
KW - coronary artery disease
KW - hybrid
KW - off-pump
KW - transaortic
KW - transcatheter aortic valve replacement
UR - http://www.scopus.com/inward/record.url?scp=85069482340&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85069482340&partnerID=8YFLogxK
U2 - 10.1111/jocs.14082
DO - 10.1111/jocs.14082
M3 - Review article
C2 - 31111565
AN - SCOPUS:85069482340
VL - 34
SP - 591
EP - 597
JO - Journal of Cardiac Surgery
JF - Journal of Cardiac Surgery
SN - 0886-0440
IS - 7
ER -