College of Medicine, The Ohio State University, Columbus, Ohio, USA.
Division of Cardiothoracic Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
J Card Surg. 2022 Nov;37(11):3935-3942. doi: 10.1111/jocs.16838. Epub 2022 Sep 13.
Combined on-pump coronary artery bypass (ONCAB) and surgical aortic valve replacement (SAVR) is the treatment of choice for concomitant severe aortic stenosis and coronary artery disease not amenable to percutaneous coronary intervention. Extensive aortic calcification and atheromatous disease may prohibit cardiopulmonary bypass and aortic cross-clamping. In these cases, anaortic off-pump coronary artery bypass (OPCAB) is a Class I (EACTS 2018) and Class IIA (AHA 2021) indication for surgical coronary revascularization. Transcatheter aortic valve replacement (TAVR) has similar benefits when compared with 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 coronary artery bypass grafting 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 multivessel 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 30 mortality or CVA in the series and all patients were discharged to home or a rehabilitation facility on Day 4-13.
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 postoperative myocardial infarction and cerebrovascular stroke.
对于同时患有严重主动脉瓣狭窄和经皮冠状动脉介入治疗不适宜的冠状动脉疾病的患者，联合体外循环冠状动脉旁路移植术（ONCAB）和外科主动脉瓣置换术（SAVR）是首选治疗方法。广泛的主动脉钙化和动脉粥样硬化疾病可能会阻止体外循环和主动脉阻断。在这些情况下，非体外循环冠状动脉旁路移植术（OPCAB）是外科冠状动脉血运重建的 I 类（EACTS 2018）和 IIA 类（AHA 2021）适应证。对于此类人群，经导管主动脉瓣置换术（TAVR）与 SAVR 相比具有相似的益处（Partner 2 & 3）。在此，我们描述了一组连续病例，这些患者同时患有冠状动脉疾病和瓣膜疾病，由于严重的主动脉疾病，传统的冠状动脉旁路移植术和 SAVR 风险过高，通过经股动脉途径进行非体外循环 OPCAB 和 TAVR。
方法/结果：在杂交手术室的同一麻醉下，8 例患者接受了非体外循环 OPCAB 和经股动脉 TAVR。7 例多血管疾病患者通过胸骨切开术使用复合移植物进行非体外循环 OPCAB，1 例 LAD 疾病患者通过达芬奇辅助的 MIDCAB 途径进行非体外循环 OPCAB。所有患者随后通过股总动脉经皮植入 Edwards Sapien 3 TAVR。该系列中无 30 天死亡率或 CVA，所有患者均于第 4-13 天出院至家庭或康复设施。
联合非体外循环 OPCAB 和经股动脉 TAVR 是治疗广泛冠状动脉疾病和严重主动脉瓣狭窄的一种安全可行的方法。主动脉无接触技术通过降低术后心肌梗死和脑血管意外的风险，为老年高危患者带来益处。
