title: Feasibility of hybrid off pump artery bypass grafting and transaortic transcatheter aortic valve implantation: A case series.
abstract: BACKGROUND
  Patients with complex coronary artery disease and severe aortic stenosis unsuitable for conventional cardiac surgery pose a significant treatment challenge. This is especially difficult for patients where percutaneous revascularization is technically very challenging and/or would not offer as complete revascularisation compared to surgical revascularisation. In addition, patients who are unsuitable for transfemoral transcatheter aortic valve implantation (TAVI) pose an additional technical challenge, particularly with dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI). As a potential solution we describe the first case series of hybrid off-pump coronary artery bypass grafting (CABG) combined with transaortic TAVI.
  
  
  RESULTS
  Over a ten-month-period, four patients underwent hybrid off-pump CABG combined with transaortic TAVI. A full sternotomy allowed off-pump arterial and vein graft anastomosis to significantly stenosed coronaries. The first three patients had severe aorto-iliac disease precluding femoral access; the fourth patient was deemed unsuitable for PCI. Transaortic TAVI using Edwards Sapien 3 valves were performed without complication in all four patients.
  
  
  CONCLUSIONS
  The hybrid off-pump CABG and transaortic TAVI procedure allows for more complete coronary revascularization, negates the need for DAPT, and minimizes treatment delay of a TAVI procedure, particularly in patients unsuitable for transfemoral access. We propose this as an important treatment option for the heart team to consider. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
authors.forename: Imthiaz
authors.identifier: http://orcid.org/0000-0001-8768-8239
authors.initials: I
authors.lastname: Manoly
authors.affiliation: Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
authors.forename: Ragheb
authors.initials: R
authors.lastname: Hasan
authors.affiliation: Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Brazier
authors.affiliation: Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
authors.forename: Vasim
authors.initials: V
authors.lastname: Farooq
authors.affiliation: Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thompson
authors.affiliation: Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
authors.forename: Devinda
authors.initials: D
authors.lastname: Karunaratne
authors.affiliation: Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
authors.forename: Heather
authors.initials: H
authors.lastname: Naylor
authors.affiliation: Central Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
authors.forename: Douglas
authors.initials: D
authors.lastname: Fraser
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D056346:Sternotomy; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects; D016896:Treatment Outcome
keywords: hybrid surgery; off-pump coronary artery bypass surgery; transcatheter aortic valve implantation