Aortic valve replacement and concomitant coronary artery bypass grafting: technical considerations in the era of sutureless and rapid-deployment aortic valves

Introduction Coexistence of severe aortic stenosis (AS) and coronary artery disease (CAD) is frequently encountered in contemporary practice, particularly amongst elderly patients with multiple comorbidities. Although transcatheter aortic valve implantation (TAVI) combined with percutaneous coronary intervention (PCI) has emerged as an alternative strategy, surgical aortic valve replacement (SAVR) with concomitant coronary artery bypass grafting (CABG) remains the reference treatment for these patient groups. The introduction of sutureless and rapid-deployment aortic valves (RDAV) has considerably expanded the surgical armamentarium, by facilitating implantation, and reducing cardiopulmonary bypass (CPB) and aortic cross-clamp times. Appropriate application of these technologies requires specific technical considerations that ultimately influence operative planning and execution.Areas covered This review summarizes contemporary evidence associated with the use of sutureless and RDAVs in combined CABG and SAVR procedures. To ensure relevant literature is included, a literature search across PubMed and ScienceDirect has been carried out, spanning the last 20 years, utilizing relevant medical subject headings (MeSH) terms and keywords.Expert opinion As evidence on sutureless and RDAVs technologies continues to accumulate, with associated advancements in perioperative planning, these valves are expected to become valuable adjuncts in combined procedures, by minimizing operative burden while also allowing for robust, aortic valve pathology correction.