title: Transaortic Transcatheter Aortic Valve Implantation and Concomitant Off Pump Revascularization.
abstract: An increasing number of patients with severe aortic stenosis and concomitant critical coronary artery disease were referred to our hospital. Some of those patients were classified as high-risk patients qualifying for a transcatheter therapy with the additional need for coronary revascularization. As a consequence of their comorbidities, the established transapical as well as transfemoral approach were either not possible or not favored owing to the indispensable need for coronary revascularization. We present 4 successfully combined off-pump procedures consisting of a transcatheter aortic valve implantation (Edwards SAPIEN XT) via the transaortic approach and an off-pump coronary artery bypass grafting. All patients were discharged free from stroke, myocardial infarction, or access site complications either to rehabilitation facility or to the referring hospital with none or trace aortic regurgitation and patent grafts. These cases confirm the feasibility of those combined operations and should be considered as realistic alternative for surgical treatment in high-risk patients who are clearly identified to benefit from transcatheter approach to treat aortic stenosis and who have severe concomitant coronary artery disease.
authors.affiliation: From the *Department of Cardiovascular Surgery and †Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany.
authors.forename: Hardy
authors.initials: H
authors.lastname: Baumbach
authors.forename: Samir
authors.initials: S
authors.lastname: Ahad
authors.forename: Stephan
authors.initials: S
authors.lastname: Hill
authors.forename: Tim
authors.initials: T
authors.lastname: Schäufele
authors.forename: Sara
authors.initials: S
authors.lastname: Adili
authors.forename: Kristina
authors.initials: K
authors.lastname: Wachter
authors.forename: Ulrich F W
authors.initials: UF
authors.lastname: Franke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000601:surgery*; D015897:Comorbidity; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003324:Coronary Artery Disease / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D011474:Prosthesis Design; D065467:Transcatheter Aortic Valve Replacement / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome