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Updated: Nov 20, 2025
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Published on: March 28, 2025
Simultaneous transaortic transcatheter aortic valve implantation and off-pump coronary artery bypass: An effective
Alina Zubarevich1, Konstantin Zhigalov1, Marcin Szczechowicz1
1Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
Insights
A hybrid approach combining transcatheter aortic valve implantation (TAVI) and off-pump coronary artery bypass (OPCAB) is a safe option for high-risk patients with severe aortic stenosis and coronary artery disease. This combined procedure demonstrated a 100% device success rate and low 30-day mortality.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Transcatheter aortic valve implantation (TAVI) is increasingly used for severe aortic stenosis (AS) across risk groups.
- Coronary artery disease (CAD) affects up to 75% of AS patients with angina.
- High mortality and complications in these patients necessitate alternative treatment strategies.
Purpose of the Study:
- To evaluate the feasibility and safety of a hybrid approach combining transaortic TAVI and off-pump coronary artery bypass (OPCAB).
- To assess outcomes in high-risk patients with severe AS and CAD undergoing simultaneous procedures.
Main Methods:
- A consecutive series of 10 high-risk patients underwent simultaneous transaortic TAVI and OPCAB between April 2014 and July 2020.
- Patient selection was based on Heart Team evaluation of comorbidities and CAD complexity.
- Study endpoints included 30-day mortality, device success, and postoperative adverse events per Valve Academic Research Consortium criteria.
Main Results:
- The mean patient age was 77.9 years, with significant comorbidities (mean logistic EuroSCORE 26.5%).
- 50% of patients had porcelain aorta; no conversions to conventional procedures were required.
- 30-day mortality was 10%, device success was 100%, and no paravalvular leakage, stroke, or myocardial infarction occurred. Complete revascularization was achieved in 70%.
Conclusions:
- A hybrid transaortic TAVI and OPCAB approach is a safe and feasible treatment option.
- This strategy is suitable for high-risk patients with severe AS and CAD ineligible for conventional treatments.
Introduction:
Transcatheter aortic valve implantation (TAVI) techniques are increasingly being adopted into clinical routine for various risk groups. Coronary artery disease (CAD) is seen in up to 75% of patients with severe aortic valve stenosis (AS) presenting with typical angina pectoris. Due to high mortality rates and procedural complications in these patients, a hybrid concept of simultaneous transaortic TAVI and off-pump coronary artery bypass (OPCAB) can be a feasible treatment option.
Methods:
Between April 2014 and July 2020, 10 consecutive high-risk patients underwent concomitant transaortic TAVI and OPCAB at our institution. All indications were discussed in Heart Team and decisions were made based on patients' comorbidities and complexity of CAD. The study endpoints were 30-day mortality, device success, and development of postoperative adverse events defined by the Valve Academic Research Consorium.
Results:
The mean age of the patients was 77.9 ± 7.1 years old. All patients presented with multiple comorbidities (mean logistic EuroSCORE 26.5 ± 12.3%, median EuroSCORE II 5.13% [interquartile range 4.2-9.5], mean STS-Score 6.04 ± 1.6%). Five patients (50%) presented with porcelain aorta. No conversion to conventional procedures was needed. 30-day mortality occurred in one patient (10%). Complete revascularization was achieved in seven (70%) of the patients. Device success rate was 100%. No paravalvular leakage was detected. No stroke, myocardial infarction or vascular complications were observed.
Conclusions:
A hybrid approach combining transaortic TAVI and OPCAB might be a safe and feasible method of treatment in high-risk patients presenting with severe AS and CAD who are not eligible for conventional surgical or interventional solutions.
