Transaortic TAVR and MICS-CABG in a Patient on Dialysis With RCA Restenosis

Severe aortic stenosis in patients undergoing dialysis often coexists with diffuse vascular and coronary calcifications, complicating access and revascularization.

A man in his 80s undergoing maintenance hemodialysis presented with heart failure and dialysis intolerance. Echocardiography revealed severe aortic stenosis, coronary angiography showed 99% ostial right coronary artery in-stent restenosis, and computed tomography demonstrated a shaggy descending aorta with unsuitable transfemoral and nonfemoral access routes but a relatively preserved ascending aorta. The heart team performed simultaneous transaortic transcatheter aortic valve replacement and minimally invasive coronary artery bypass grafting using a saphenous vein graft to the posterior descending artery. A 29-mm Evolut FX (Medtronic) valve was successfully implanted.

This strategy avoided sternotomy, cardiopulmonary bypass, hostile peripheral access, and repeat ostial percutaneous coronary intervention.

Simultaneous transaortic transcatheter aortic valve replacement and minimally invasive coronary artery bypass grafting may be useful when standard access and durable percutaneous coronary intervention are unsuitable.