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August 1, 2026International Heart JournalOpen Access

Hybrid TAV-in-TAV with off-pump CABG succeeds without complications in a high-risk coronary obstruction case.

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Why the study?

Few reports have described TAV-in-TAV with simultaneous surgical coronary revascularization to prevent coronary obstruction in patients unsuitable for conventional transcatheter preventive techniques.

Population

A 90-year-old woman with prior TAVR, symptomatic structural valve deterioration, and high risk of coronary obstruction

Design

Case report

Key result

A hybrid strategy combining TAV-in-TAV with concomitant off-pump coronary artery bypass grafting was successfully performed without complications in a 90-year-old woman at high risk for coronary obstruction.

Authors

KFkosaku fuwaTITeruhiko ImamuraHOHironori Osawa

Discussion

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Overview

Supports hybrid feasibility in high-risk SVD cases; hypothesis-generating and requires prospective validation before broader use.

Key Points

  • To report a successful hybrid approach of TAV-in-TAV with off-pump coronary artery bypass for a high-risk patient.
  • Patient: 90-year-old woman with prior TAVR and symptomatic valve deterioration.
  • Procedure: Combined off-pump coronary artery bypass grafting to the left anterior descending artery with TAV-in-TAV.
  • Outcome measures included postoperative imaging for valve function and graft patency.
  • The hybrid procedure was completed successfully without complications.
  • Postoperative imaging showed good prosthetic valve function.
  • Graft patency and preserved coronary flow were confirmed.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P
Population
A 90-year-old woman with prior TAVR and symptomatic structural valve deterioration, at high risk for coronary obstruction due to a short valve-to-coronary distance, who underwent a hybrid TAV-in-TAV and OPCAB procedure.
I
Intervention
Hybrid strategy combining valve-in-valve TAVR (TAV-in-TAV) with concomitant off-pump coronary artery bypass grafting to the left anterior descending artery.
O
Outcome
Procedural success (completion without complications, good prosthetic valve function, graft patency, and preserved coronary flow on postoperative imaging)

A hybrid surgical-transcatheter strategy combining TAV-in-TAV with off-pump CABG is a feasible approach for coronary protection in anatomically high-risk patients with structural valve deterioration.

Limitations

  • Single case report
  • Further studies are warranted to validate the safety, feasibility, and long-term outcomes of such hybrid strategies in selected patients

Cite This Study

fuwa et al. (2026) conducted a case report in Symptomatic structural valve deterioration post-TAVR with high risk of coronary obstruction (n=1). TAV-in-TAV with concomitant off-pump coronary artery bypass (OPCAB) was evaluated on Procedural success and prevention of coronary obstruction. A hybrid strategy combining TAV-in-TAV with concomitant off-pump coronary artery bypass grafting was successfully performed without complications in a 90-year-old woman at high risk for coronary obstruction.

synapsesocial.com/papers/6a6da8e1e258b358b3c6c9b7https://doi.org/10.1536/ihj.25-729
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