title: Combined transapical aortic valve replacement and minimally invasive direct coronary bypass grafting--a new concept for selected high-risk patients.
abstract: BACKGROUND
  Transcatheter aortic valve implantation and minimally invasive direct coronary artery bypass (MIDCAB) procedures are both off-pump treatment options for a subset of higher-risk patients. We present a new, minimally invasive surgical concept involving combining the procedures and performing them through the same thoracic access in a patient with a vascular disorder.
  
  
  METHODS
  We report on a 78-year-old patient with symptomatic calcified aortic stenosis and a critical lesion of the left anterior descending coronary artery. In addition, Rendu-Osler-Weber disease was diagnosed. He was successfully treated with combined off-pump transapical, transcatheter aortic valve implantation and MIDCAB grafting. The initial postoperative recovery was good; however, the patient died 3 months postoperatively from septic complications.
  
  
  CONCLUSIONS
  This combined procedure performed through the same anterolateral incision was technically feasible and may be a promising, minimally invasive approach for selected patients.
authors.affiliation: Department of Cardiac Surgery, University of Bonn, Sigmund-Freud-Strasse 25, Bonn, Germany. fritz.mellert@uni-bonn.de
authors.forename: Fritz
authors.initials: F
authors.lastname: Mellert
authors.forename: Johannes
authors.initials: J
authors.lastname: Breuer
authors.forename: Chris
authors.initials: C
authors.lastname: Probst
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schiller
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery*; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome