Concomitant Anaortic OPCAB and Transfemoral TAVR for High-Risk Patients:
A Case Series
Abstract
Background Combined ONCAB and SAVR is the treatment of choice
for concomitant severe aortic stenosis and coronary artery disease not
amenable to PCI intervention. Extensive aortic calcification and
atheromatous disease may prohibit cardiopulmonary bypass and aortic
cross clamping. In these cases Anaortic OPCAB is a Class I (EACTS 2018)
and Class IIA (AHA 2021) indication for surgical coronary
revascularization. TAVR has similar benefits when compared to SAVR for
this population (Partner 2 & 3). Herewith we describe a case series of
concomitant Anaortic OPCAB and TAVR via the transfemoral approach for
patients with coronary artery and valve disease considered too high risk
for traditional CABG and SAVR due to severe aortic disease.
Methods/Results Eight patients underwent anaortic OPCAB and
transfemoral TAVR during the same anesthetic in a hybrid operating room.
Seven patients with multi-vessel disease had anaortic OPCAB via a
sternotomy using composite grafts, one patient with LAD disease had
anaortic OPCAB using a Da Vinci assisted MIDCAB approach. All patients
then had an Edwards Sapien 3 TAVR placed percutaneously via the common
femoral artery. There was no thirty-day mortality or CVA in the series
and all patients were discharged to home or a rehabilitation facility on
day 4-13. Conclusions Combined anaortic OPCAB and transfemoral
TAVR is a safe and feasible approach to treating concomitant extensive
coronary artery disease and severe aortic stenosis. The aortic no-touch
technique provides benefits in the elderly high-risk patients by
reducing the risk of post-operative myocardial infarction and
cerebrovascular stroke.