Hybrid approach combining off-pump CABG with transapical aortic valve implantation via median sternotomy

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Hybrid Cardiac Procedures

Background:

• Severe aortic stenosis and complex coronary artery disease often preclude traditional surgical intervention due to high patient risk.
• The patient presented with multiple comorbidities, including chronic renal insufficiency, prior stroke, and pulmonary hypertension, resulting in a high predicted surgical mortality risk (EuroSCORE: 34%; STS: 14.9%).

Observation:

• The patient was deemed unsuitable for conventional aortic valve replacement surgery.
• A median sternotomy approach was utilized for the hybrid procedure.

Findings:

• The hybrid treatment successfully combined off-pump coronary artery bypass grafting (CABG) with transapical aortic valve implantation.
• Crucially, the entire procedure was performed without the need for extracorporeal circulation (heart-lung machine).

Implications:

• This case demonstrates the feasibility and potential benefit of a hybrid surgical strategy in high-risk patients with complex cardiac conditions.
• Avoiding extracorporeal circulation may reduce the risks associated with cardiopulmonary bypass, potentially improving outcomes in select patient populations.