International Society For Minimally Invasive Cardiothoracic Surgery

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Combined Off Pump Coronary Bypass And Transcatheter Aortic Valve Replacement: A Hybrid Alternative In High Risk Patients
Steven J. Hoff, MD, Deepak P. Vivek, MD, Mark E. Sand, MD, Jeffrey N. Bott, MD, Vijay S. Kasi, MD, Stephen K. Ball, MD, Deborah Shaw, RN, Robin Vogel, PA-C.
Orlando Health Heart Institute, Orlando, FL, USA.

Objectives: Combined off-pump coronary bypass and transcatheter aortic valve replacement (TAVR) has been described as a treatment option in patients with severe aortic stenosis and complex coronary disease that cannot be managed interventionally. We report our experience in this high risk group of patients with intermediate term follow-up. Methods: From October 2015 to November 2017, 6 patients underwent combined off-pump coronary bypass and transcatheter aortic valve replacement in our institution. 5 patients underwent multivessel off-pump coronary bypass (OPCAB) with transaortic TAVR, while one patient underwent minimally invasive direct coronary bypass (MIDCAB) with transfemoral TAVR. Retrospective chart review was performed. Results: The mean age at the time of operation was 86 years (Range 76-91 years). The average number of grafts performed was 3.3 (Range 1-5). There were no operative deaths or serious complications. The mean postoperative length of stay was 7.8 days (Range 6-10 days). 30-day and one year survival rates were 100% and 83% respectively. One patient was readmitted to the hospital 2 months postoperatively with a gastrointestinal hemorrhage and lacunar stroke and died in hospice. The remaining 5 patients are alive and well at a mean follow-up of 22 months (Range 11-35 months). Conclusions: Combined off-pump surgical coronary revascularization and transcatheter aortic valve replacement may provide a reasonable option in highly selected patients with severe aortic stenosis who are not candidates for conventional surgery with complex coronary disease which cannot be managed interventionally.

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