Related Experiment Video
Updated: Aug 27, 2025
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Efficacy of Off-Pump Coronary Artery Bypass Grafting With Concomitant Transcatheter Aortic Valve Replacement
Yusuke Shimahara1, Satsuki Fukushima2, Hideaki Kanzaki3
1Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan.
Insights
Concomitant off-pump coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR) is a less-invasive option. This combined procedure showed similar outcomes to on-pump CABG with surgical aortic replacement in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology
Background:
- Coronary artery disease and aortic stenosis often coexist, necessitating complex surgical interventions.
- Traditional surgical approaches involve significant invasiveness and associated risks, particularly for high-risk patients.
Purpose of the Study:
- To evaluate the early and intermediate-term outcomes of patients undergoing combined off-pump coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR).
- To compare the safety and efficacy of this combined off-pump CABG and TAVR approach against conventional on-pump CABG with surgical aortic valve replacement.
Main Methods:
- A retrospective study comparing 49 patients who underwent concomitant off-pump CABG and TAVR (TAVRCAB group) with 80 eligible patients who had on-pump CABG and surgical aortic replacement (SAVRCAB group).
- The composite endpoint included all-cause death, heart failure rehospitalization, repeat revascularization, brain infarction, and repeat aortic valve replacement.
- Data collected between January 2014 and June 2021.
Main Results:
- The TAVRCAB group had higher predicted mortality risk and age but experienced shorter surgical times.
- No conversions to on-pump surgery were noted in the TAVRCAB group.
- Both groups showed similar rates of freedom from the composite event, with no deep sternal wound infections or repeat revascularizations. The TAVRCAB group had a lower postoperative maximum creatinine kinase-MB value and no hospital deaths or brain infarctions.
Conclusions:
- Concomitant off-pump CABG and TAVR presents a less-invasive alternative for patients with aortic stenosis and coronary artery disease who are unsuitable for percutaneous coronary intervention.
- This approach offers comparable outcomes to traditional on-pump CABG and surgical aortic replacement in intermediate to high-risk surgical patients.
Aim:
This study aimed to evaluate the early and intermediate-term outcomes of patients who underwent concomitant off-pump coronary artery bypass grafting (CABG) and transcatheter aortic valve replacement (TAVR).
Method:
Between January 2014 and June 2021, 49 patients underwent concomitant off-pump CABG and TAVR via median sternotomy (TAVRCAB group) and 143 underwent concomitant on-pump CABG and surgical aortic replacement. Of the 143 patients who underwent on-pump surgery, 80 (SAVRCAB group) were eligible for comparison. The composite event included all-cause death, heart failure rehospitalisation, repeat revascularisation, brain infarction, and repeat aortic valve replacement.
Results:
The Society of Thoracic Surgeons' predicted risk for mortality and age were higher in the TAVRCAB group than in the SAVRCAB group (7.1% vs 3.1% [p<0.001]; 81 yrs vs 75 years [p<0.001], respectively), while the surgical time was shorter (289 min vs 352 min; p<0.001). There was no conversion to on-pump surgery in the TAVRCAB group. The postoperative maximum creatinine kinase-MB value was lower in the TAVRCAB group. There was no deep sternal wound infection or repeat revascularisation in either group. Hospital death and brain infarction developed in one patient (1.3%) each in the SAVRCAB group, but in no patients in the TAVRCAB group. The rates of freedom from the composite event were similar between the two groups during the follow-up period.
Conclusions:
Concomitant off-pump CABG and TAVR would be a less-invasive alternative procedure for treating intermediate or high surgical risk patients with aortic stenosis and coronary artery disease unsuitable for percutaneous coronary intervention.
More Related Videos
05:31Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
Published on: June 8, 2022
12:17Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017