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Concomitant Anaortic OPCAB and Transfemoral TAVR for High-Risk Patients: A Case Series
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  • Dariya Hardisky,
  • Ammu Vijayakumar,
  • Bryan Whitson,
  • Scott Lilly M,
  • K. Dean Boudoulas,
  • Michael P. Vallely
Dariya Hardisky
The Ohio State University College of Medicine
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Ammu Vijayakumar
The Ohio State University Wexner Medical Center Department of Surgery
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Bryan Whitson
The Ohio State University Wexner Medical Center Department of Surgery
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Scott Lilly M
The Ohio State University Wexner Medical Center
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K. Dean Boudoulas
The Ohio State University Wexner Medical Center
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Michael P. Vallely
The Ohio State University Wexner Medical Center Department of Surgery
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Abstract

Background Combined ONCAB and SAVR is the treatment of choice for concomitant severe aortic stenosis and coronary artery disease not amenable to PCI intervention. Extensive aortic calcification and atheromatous disease may prohibit cardiopulmonary bypass and aortic cross clamping. In these cases Anaortic OPCAB is a Class I (EACTS 2018) and Class IIA (AHA 2021) indication for surgical coronary revascularization. TAVR has similar benefits when compared to SAVR for this population (Partner 2 & 3). Herewith we describe a case series of concomitant Anaortic OPCAB and TAVR via the transfemoral approach for patients with coronary artery and valve disease considered too high risk for traditional CABG and SAVR due to severe aortic disease. Methods/Results Eight patients underwent anaortic OPCAB and transfemoral TAVR during the same anesthetic in a hybrid operating room. Seven patients with multi-vessel disease had anaortic OPCAB via a sternotomy using composite grafts, one patient with LAD disease had anaortic OPCAB using a Da Vinci assisted MIDCAB approach. All patients then had an Edwards Sapien 3 TAVR placed percutaneously via the common femoral artery. There was no thirty-day mortality or CVA in the series and all patients were discharged to home or a rehabilitation facility on day 4-13. Conclusions Combined anaortic OPCAB and transfemoral TAVR is a safe and feasible approach to treating concomitant extensive coronary artery disease and severe aortic stenosis. The aortic no-touch technique provides benefits in the elderly high-risk patients by reducing the risk of post-operative myocardial infarction and cerebrovascular stroke.
18 Jul 2022Submitted to Journal of Cardiac Surgery
21 Jul 2022Assigned to Editor
21 Jul 2022Submission Checks Completed
21 Jul 2022Reviewer(s) Assigned
28 Jul 2022Review(s) Completed, Editorial Evaluation Pending
28 Jul 2022Editorial Decision: Accept