Combined transapical TAVI and MIDCAB through a single incision is technically feasible for selected high-risk patients with concomitant aortic stenosis and coronary artery disease.
Single-case feasibility with late septic death warrants caution; leaves open prospective safety evaluation in high-risk aortic stenosis with CAD.
BACKGROUND: Transcatheter aortic valve implantation and minimally invasive direct coronary artery bypass (MIDCAB) procedures are both off-pump treatment options for a subset of higher-risk patients. We present a new, minimally invasive surgical concept involving combining the procedures and performing them through the same thoracic access in a patient with a vascular disorder. CASE REPORT: We report on a 78-year-old patient with symptomatic calcified aortic stenosis and a critical lesion of the left anterior descending coronary artery. In addition, Rendu-Osler-Weber disease was diagnosed. He was successfully treated with combined off-pump transapical, transcatheter aortic valve implantation and MIDCAB grafting. The initial postoperative recovery was good; however, the patient died 3 months postoperatively from septic complications. CONCLUSION: This combined procedure performed through the same anterolateral incision was technically feasible and may be a promising, minimally invasive approach for selected patients.
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Mellert et al. (2011) studied this question.
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