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Hybrid Minimally Invasive Approach for Combined Obstructive Coronary Artery Disease and Severe Aortic Stenosis

Luigi Pirelli1, Nirav C Patel1, Jacob S Scheinerman1

  • 15945 Department of Cardiothoracic Surgery, Lenox Hill Heart and Lung, Northwell Health System, New York, NY, USA.

Innovations (Philadelphia, Pa.)
|January 3, 2020
PubMed

Insights

A hybrid approach combining minimally invasive bypass surgery (MIDCAB) and transcatheter aortic valve replacement (TAVR) is feasible for treating complex coronary artery disease (CAD) and severe aortic stenosis (AS) in high-risk patients.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Hybrid Procedures

Background:

  • Concomitant coronary artery disease (CAD) and severe aortic stenosis (AS) present a complex clinical challenge.
  • Treatment options for combined CAD and AS include invasive and percutaneous approaches.

Purpose of the Study:

  • To evaluate the feasibility, efficacy, and safety of a staged hybrid approach.
  • Utilizing minimally invasive direct coronary artery bypass surgery (MIDCAB) followed by transcatheter aortic valve replacement (TAVR) for complex CAD and AS.

Main Methods:

  • Six high-risk patients with complex CAD (not amenable to PCI) and severe AS underwent staged MIDCAB and TAVR.
  • Procedures included single-vessel MIDCAB, with some patients requiring additional PCI, balloon aortic valvuloplasty, or MitraClip for mitral regurgitation.

Main Results:

  • No intraprocedural or hospital mortality was observed.
  • No neurological deficits or vascular complications occurred.
  • The average SYNTAX score was 22±8 and STS score for surgical AVR was 8±3%.

Conclusions:

  • A hybrid staged approach combining MIDCAB, PCI, and TAVR is a viable option for high-risk patients with complex CAD and severe AS.
  • Procedure sequencing and timing should be individualized based on patient factors and disease severity.
Abstract

Keywords:
PCITAVRaortic stenosiscoronary artery diseaseminimally invasive OPCAB

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