title: Aortic Valve Stenosis and Left Main Coronary Disease: Hybrid Approach.
abstract: We describe a technique of combined transcatheter aortic valve replacement (TAVR), off-pump single coronary artery bypass, and percutaneous coronary intervention (PCI) in a high-risk patient presenting with unstable angina and severe heart failure. This patient had documented moderate to severe aortic stenosis, left ventricular dysfunction, and a heavily calcified ascending aorta. A robotic-assisted left internal thoracic artery harvesting was aborted owing to inability to tolerate single-lung ventilation. A median sternotomy was done, then successful off-pump single-vessel bypass, PCI, and TAVR were achieved. The patient recovered and was discharged from hospital in stable condition.
authors.affiliation: From the *Division of Cardiac Surgery, †Division of Anesthesia, and ‡Division of Cardiology, London Health Sciences Center, London, Ontario, Canada.
authors.forename: Hussein A
authors.initials: HA
authors.lastname: Al-Amodi
authors.forename: Hamad F
authors.initials: HF
authors.lastname: Alhabib
authors.forename: Marc
authors.initials: M
authors.lastname: St-Amand
authors.forename: Ivan
authors.initials: I
authors.lastname: Iglesias
authors.forename: Patrick
authors.initials: P
authors.lastname: Teefy
authors.forename: Michael W A
authors.initials: MW
authors.lastname: Chu
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
mesh_terms: D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000601:surgery*; D006328:Cardiac Catheterization / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006333:Heart Failure / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011859:Radiography; D065287:Robotic Surgical Procedures / Q000379:methods; D056346:Sternotomy / Q000379:methods; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis