Key result
Simultaneous transaortic TAVR and MICS-CABG succeeds in a dialysis patient, avoiding sternotomy and hostile access.
Why the study?
Severe aortic stenosis in patients undergoing dialysis often coexists with diffuse vascular and coronary calcifications, complicating access and revascularization.
Case Report (n=1)
Simultaneous transaortic TAVR and MICS-CABG is a feasible strategy for patients with severe aortic stenosis and complex coronary disease when standard access routes and durable PCI are unsuitable.
May support hybrid transaortic TAVR with MICS-CABG in select complex cases; hypothesis-generating and requires prospective validation before practice change.
BACKGROUND: Severe aortic stenosis in patients undergoing dialysis often coexists with diffuse vascular and coronary calcifications, complicating access and revascularization. CASE SUMMARY: A man in his 80s undergoing maintenance hemodialysis presented with heart failure and dialysis intolerance. Echocardiography revealed severe aortic stenosis, coronary angiography showed 99% ostial right coronary artery in-stent restenosis, and computed tomography demonstrated a shaggy descending aorta with unsuitable transfemoral and nonfemoral access routes but a relatively preserved ascending aorta. The heart team performed simultaneous transaortic transcatheter aortic valve replacement and minimally invasive coronary artery bypass grafting using a saphenous vein graft to the posterior descending artery. A 29-mm Evolut FX (Medtronic) valve was successfully implanted. DISCUSSION: This strategy avoided sternotomy, cardiopulmonary bypass, hostile peripheral access, and repeat ostial percutaneous coronary intervention. TAKE-HOME MESSAGE: Simultaneous transaortic transcatheter aortic valve replacement and minimally invasive coronary artery bypass grafting may be useful when standard access and durable percutaneous coronary intervention are unsuitable.
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Sai et al. (2026) conducted a case report in Severe aortic stenosis and ostial right coronary artery in-stent restenosis (n=1). Simultaneous transaortic TAVR and MICS-CABG was evaluated. Simultaneous transaortic TAVR and MICS-CABG was successfully performed in a dialysis patient with severe aortic stenosis and RCA restenosis, avoiding sternotomy and hostile peripheral access.
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