title: Interdisciplinary three-step strategy to treat aortic stenosis and coronary artery disease in a patient with end-stage chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Valvular aortic stenosis is a common disease in the elderly, often in multimorbid patients. It is often associated with coronary artery disease and peripheral artery disease. In this situation, the risk of conventional open-heart surgery is too high, and other treatment strategies have to be evaluated.
  
  
  METHODS
  A 79-year-old female patient with severe aortic stenosis, coronary artery disease and end-stage chronic obstructive pulmonary disease suffering from dyspnea at rest and permanently dependent on oxygen was treated in three steps. Firstly, her pulmonary infection was treated with antibiotics for 7 days. Then, the left anterior descending artery was stented (bare-metal stent). In the same session, valvuloplasty of the aortic valve was performed. She was sent to rehabilitation to improve her pulmonary condition and took clopidogrel for 4 weeks. Finally, she underwent transapical aortic valve replacement. She was released to rehabilitation on postoperative day 12.
  
  
  CONCLUSIONS
  A combination of modern interventional and minimally invasive surgical techniques to treat aortic stenosis and coronary heart disease can be a viable option for multimorbid patients with extremely high risk in conventional open-heart surgery.
authors.affiliation: Department of Cardiac Surgery, Ludwig Maximilians University of Munich, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Michel
authors.forename: Amir K
authors.initials: AK
authors.lastname: Bigdeli
authors.forename: Andres
authors.initials: A
authors.lastname: Beiras-Fernandez
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.forename: Manuel
authors.initials: M
authors.lastname: Wolf
authors.forename: Ralf
authors.initials: R
authors.lastname: Sodian
authors.forename: Ingo
authors.initials: I
authors.lastname: Kaczmarek