Baumbach Hardy, Ahad Samir, Hill Stephan, Schäufele Tim, Adili Sara, Wachter Kristina, Franke Ulrich F W
From the *Department of Cardiovascular Surgery and †Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany.
Innovations (Phila). 2016 Sep/Oct;11(5):363-366. doi: 10.1097/IMI.0000000000000293.
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.
越来越多患有严重主动脉瓣狭窄并伴有严重冠状动脉疾病的患者被转诊至我院。其中一些患者被归类为高危患者，符合经导管治疗条件，且额外需要进行冠状动脉血运重建。由于他们的合并症，既定的经心尖以及经股动脉入路，要么不可行，要么因冠状动脉血运重建的必要性而不被青睐。我们展示了4例成功的非体外循环联合手术，包括经主动脉入路的经导管主动脉瓣植入术（爱德华SAPIEN XT）和非体外循环冠状动脉旁路移植术。所有患者均无中风、心肌梗死或穿刺部位并发症出院，要么前往康复机构，要么回到转诊医院，无一或仅有微量主动脉瓣反流，移植血管通畅。这些病例证实了这些联合手术的可行性，对于明确受益于经导管方法治疗主动脉瓣狭窄且伴有严重冠状动脉疾病的高危患者，应将其视为手术治疗的切实可行的替代方案。
