Minimally invasive off-pump aortic valve implantation: the surgical safety net

Minimally invasive techniques for transcatheter aortic valve implantation are rapidly developing. Feasibility of off-pump, sternal-sparing aortic valve implantation has already been demonstrated, initial clinical results are promising, and there will be further technical improvements. However, any complication, some even unknown thus far, can occur at any time during transcatheter aortic valve implantation requiring conversion to cardiopulmonary bypass and conventional surgery. We present a case of left mainstem occlusion during minimally invasive off-pump transapical aortic valve implantation focusing on bail-out strategies. Due to the "surgical safety-net," cardiopulmonary bypass was immediately established, and after coronary bypass grafting, the patient recovered and was discharged from the hospital.