Why the study?
Patients on hemodialysis with concomitant severe AS and multivessel CAD face high surgical risk for SAVR and CABG, necessitating alternative minimally invasive strategies.
Case Report (n=1)
No
Simultaneous right transsubclavian TAVI and MICS-CABG following staged PCI offers a feasible, minimally invasive alternative avoiding median sternotomy and femoral access in high-risk hemodialysis patients with severe aortic stenosis, complex multivessel CAD, and severe aortopathy.
Supports feasibility of combined minimally invasive TAVI and CABG in select high-risk patients; leaves open need for prospective validation.
Patients on hemodialysis with concomitant severe aortic stenosis (AS) and multivessel coronary artery disease (CAD) are at high risk for surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). Transsubclavian–transcatheter aortic valve implantation (TSc‐TAVI) is a well‐established alternative approach to transfemoral TAVI for patients with unfavorable femoral access. Herein, we report a case in which minimally invasive surgical treatment and TSc‐TAVI were performed simultaneously in a patient with severe AS and multivessel CAD undergoing hemodialysis. An 85‐year‐old man undergoing hemodialysis for end‐stage renal disease owing to severe AS (mean pressure gradient, 46 mmHg; aortic valve area, 0.75 cm 2 ; and left ventricular ejection fraction, 59%) presented to our hospital with chest pain on exertion. Preoperative coronary angiography revealed significant stenosis of the left anterior descending (LAD) coronary artery and right coronary artery (RCA), requiring revascularization. However, the patient was not a good candidate for transfemoral TAVI because of a porcelain ascending aorta and a shaggy descending aorta observed on computed tomography. He was scheduled for concomitant right TSc‐TAVI and minimally invasive cardiac surgery (MICS)–CABG after percutaneous coronary intervention (PCI) for the RCA. The treatment was successful. Simultaneous TSc‐TAVI and MICS‐CABG with PCI may be applied as a minimally invasive surgical treatment modality for patients with AS and CAD undergoing hemodialysis.
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Wada et al. (2025) conducted a case report in Severe aortic stenosis and multivessel coronary artery disease on hemodialysis (n=1). Staged PCI (orbital atherectomy and drug-coated balloon to RCA) followed 1 week later by simultaneous right transsubclavian TAVI (26-mm Sapien 3) and MICS-CABG (LITA-LAD and LITA-SVG-Dg) was evaluated on Procedural success, echocardiographic hemodynamics, and 1-year clinical and graft patency outcomes.
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