Alina Zubarevich1, Konstantin Zhigalov1, Marcin Szczechowicz1, Matthias Thielmann1, Marco Rabis2, Jef Van den Eynde3, Michel Pompeu B O Sá4, Wilko Weissenberger1, Bakytbek Kadyraliev5, Soslan Enginoev6, Rolf Alexander Jánosi7, Alexander Lind7, Tienush Rassaf7, Bastian Schmack1, Arjang Ruhparwar1, Alexander Weymann1, Daniel Wendt1. 1. Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany. 2. Department of Anesthesiology, University of Duisburg-Essen, Essen, Germany. 3. Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium. 4. Department of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco (PROCAPE), Recife, Pernambuco, Brazil. 5. Department of Cardiovascular Surgery, S.G. Sukhanov Federal Center of Cardiovascular Surgery, E.A. Vagner Perm State Medical University, Perm, Russia. 6. Federal Center for Cardiovascular Surgery, Department of Cardiovascular Surgery, Astrakhan State Medical University, Astrakhan, Russia. 7. Department of Cardiology & Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany.
Abstract
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) techniques are increasingly being adopted into clinical routine for various risk groups. Coronary artery disease (CAD) is seen in up to 75% of patients with severe aortic valve stenosis (AS) presenting with typical angina pectoris. Due to high mortality rates and procedural complications in these patients, a hybrid concept of simultaneous transaortic TAVI and off-pump coronary artery bypass (OPCAB) can be a feasible treatment option. METHODS: Between April 2014 and July 2020, 10 consecutive high-risk patients underwent concomitant transaortic TAVI and OPCAB at our institution. All indications were discussed in Heart Team and decisions were made based on patients' comorbidities and complexity of CAD. The study endpoints were 30-day mortality, device success, and development of postoperative adverse events defined by the Valve Academic Research Consorium. RESULTS: The mean age of the patients was 77.9 ± 7.1 years old. All patients presented with multiple comorbidities (mean logistic EuroSCORE 26.5 ± 12.3%, median EuroSCORE II 5.13% [interquartile range 4.2-9.5], mean STS-Score 6.04 ± 1.6%). Five patients (50%) presented with porcelain aorta. No conversion to conventional procedures was needed. 30-day mortality occurred in one patient (10%). Complete revascularization was achieved in seven (70%) of the patients. Device success rate was 100%. No paravalvular leakage was detected. No stroke, myocardial infarction or vascular complications were observed. CONCLUSIONS: A hybrid approach combining transaortic TAVI and OPCAB might be a safe and feasible method of treatment in high-risk patients presenting with severe AS and CAD who are not eligible for conventional surgical or interventional solutions.
INTRODUCTION: Transcatheter aortic valve implantation (TAVI) techniques are increasingly being adopted into clinical routine for various risk groups. Coronary artery disease (CAD) is seen in up to 75% of patients with severe aortic valve stenosis (AS) presenting with typical angina pectoris. Due to high mortality rates and procedural complications in these patients, a hybrid concept of simultaneous transaortic TAVI and off-pump coronary artery bypass (OPCAB) can be a feasible treatment option. METHODS: Between April 2014 and July 2020, 10 consecutive high-risk patients underwent concomitant transaortic TAVI and OPCAB at our institution. All indications were discussed in Heart Team and decisions were made based on patients' comorbidities and complexity of CAD. The study endpoints were 30-day mortality, device success, and development of postoperative adverse events defined by the Valve Academic Research Consorium. RESULTS: The mean age of the patients was 77.9 ± 7.1 years old. All patients presented with multiple comorbidities (mean logistic EuroSCORE 26.5 ± 12.3%, median EuroSCORE II 5.13% [interquartile range 4.2-9.5], mean STS-Score 6.04 ± 1.6%). Five patients (50%) presented with porcelain aorta. No conversion to conventional procedures was needed. 30-day mortality occurred in one patient (10%). Complete revascularization was achieved in seven (70%) of the patients. Device success rate was 100%. No paravalvular leakage was detected. No stroke, myocardial infarction or vascular complications were observed. CONCLUSIONS: A hybrid approach combining transaortic TAVI and OPCAB might be a safe and feasible method of treatment in high-risk patients presenting with severe AS and CAD who are not eligible for conventional surgical or interventional solutions.
Authors: Alina Zubarevich; Marcin Szczechowicz; Konstantin Zhigalov; Philipp Marx; Alexander Lind; Rolf Alexander Jánosi; Tienush Rassaf; Sharaf-Eldin Shehada; Rizwan Malik; Markus Kamler; Matthias Thielmann; Bastian Schmack; Arjang Ruhparwar; Alexander Weymann; Daniel Wendt Journal: Ann Cardiothorac Surg Date: 2021-09
Authors: Alina Zubarevich; Marcin Szczechowicz; Arian Arjomandi Rad; Robert Vardanyan; Philipp Marx; Alexander Lind; Rolf Alexander Jánosi; Mehdy Roosta-Azad; Rizwan Malik; Markus Kamler; Matthias Thielmann; Mohamed El Gabry; Bastian Schmack; Arjang Ruhparwar; Alexander Weymann; Daniel Wendt Journal: PLoS One Date: 2021-08-25 Impact factor: 3.240