Hybrid Minimally Invasive Approach for Combined Obstructive Coronary Artery Disease and Severe Aortic Stenosis

被引:9
作者
Pirelli, Luigi [1 ]
Patel, Nirav C. [1 ]
Scheinerman, Jacob S. [1 ]
Brinster, Derek R. [1 ]
Hemli, Jonathan M. [1 ]
Basman, Craig [1 ]
Kliger, Chad A. [1 ]
机构
[1] Northwell Hlth Syst, Dept Cardiothorac Surg, Lenox Hill Heart & Lung, 130 East 77th St,4th Floor Black Hall, New York, NY 10075 USA
关键词
aortic stenosis; coronary artery disease; TAVR; minimally invasive OPCAB; PCI; VALVE-REPLACEMENT; INTERVENTION;
D O I
10.1177/1556984519896581
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: There is a high prevalence of concomitant coronary artery disease (CAD) and aortic stenosis (AS), and these conditions can be treated with a variety of invasive and/or percutaneous approaches. The aim of this study is to demonstrate the feasibility, efficacy, and safety of a staged transcatheter aortic valve replacement (TAVR) after a hybrid minimally invasive direct coronary artery bypass surgery (MIDCAB) to treat combined complex CAD and AS. Methods: Six patients with concomitant CAD and severe AS underwent staged treatment of their CAD with MIDCAB and TAVR. All patients had significant complex left main or left anterior descending artery (LAD) stenosis deemed to be not amenable to percutaneous coronary intervention (PCI). Results: The average syntax score was 22 +/- 8 and the Society of Thoracic Surgeons score for surgical AVR was 8 +/- 3%. All patients underwent a single vessel MIDCAB for revascularization of the LAD (three patients required additional PCI for non-LAD disease). Two patients had pre-TAVR balloon aortic valvuloplasty and one patient also required treatment of severe mitral valve regurgitation with percutaneous edge-to-edge repair (the MitraClip). There was no intraprocedural or hospital mortality. No neurological deficits or vascular complications were recorded. Conclusions: A hybrid staged approach for combined complex CAD and severe AS with MIDCAB, PCI, and TAVR is a valid option in high-risk patients. The order and timing of these procedures must be tailored to the patient's clinical symptoms, stability, and severity of disease.
引用
收藏
页码:131 / 137
页数:7
相关论文
共 14 条
[1]   Single-stage hybrid coronary revascularization with long-term follow-up [J].
Adams, Corey ;
Burns, Daniel J. P. ;
Chu, Michael W. A. ;
Jones, Philip M. ;
Shridar, Kumar ;
Teefy, Patrick ;
Kostuk, William J. ;
Dobkowski, Wojciech B. ;
Romsa, Jonathan ;
Kiaii, Bob .
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2014, 45 (03) :438-443
[2]   Transcatheter aortic valve replacement- management of patients with significant coronary artery disease undergoing aortic valve interventions: surgical compared to catheter-based approaches in hybrid procedures [J].
Baumbach, Hardy ;
Schairer, Eva R. ;
Wachter, Kristina ;
Rustenbach, Christian ;
Ahad, Samir ;
Stan, Alina ;
Hill, Stephan ;
Bramlage, Peter ;
Franke, Ulrich F. W. ;
Schaeufele, Tim .
BMC CARDIOVASCULAR DISORDERS, 2019, 19 (1)
[3]   Percutaneous Coronary Intervention in Patients With Severe Aortic Stenosis Implications for Transcatheter Aortic Valve Replacement [J].
Goel, Sachin S. ;
Agarwal, Shikhar ;
Tuzcu, E. Murat ;
Ellis, Stephen G. ;
Svensson, Lars G. ;
Zaman, Tarique ;
Bajaj, Navkaranbir ;
Joseph, Lee ;
Patel, Neil S. ;
Aksoy, Olcay ;
Stewart, William J. ;
Griffin, Brian P. ;
Kapadia, Samir R. .
CIRCULATION, 2012, 125 (08) :1005-U104
[4]  
Hemli JM, 2012, INNOVATIONS, V7, P399, DOI 10.1097/IMI.0b013e3182851779
[5]  
Kadric Nedzad, 2015, Med Arch, V69, P54, DOI 10.5455/medarh.2015.69.54-57
[6]   Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. [J].
Leon, Martin B. ;
Smith, Craig R. ;
Mack, Michael ;
Miller, D. Craig ;
Moses, Jeffrey W. ;
Svensson, Lars G. ;
Tuzcu, E. Murat ;
Webb, John G. ;
Fontana, Gregory P. ;
Makkar, Raj R. ;
Brown, David L. ;
Block, Peter C. ;
Guyton, Robert A. ;
Pichard, Augusto D. ;
Bavaria, Joseph E. ;
Herrmann, Howard C. ;
Douglas, Pamela S. ;
Petersen, John L. ;
Akin, Jodi J. ;
Anderson, William N. ;
Wang, Duolao ;
Pocock, Stuart .
NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (17) :1597-1607
[7]  
LUND O, 1990, J THORAC CARDIOV SUR, V100, P327
[8]   Burden of valvular heart diseases: a population-based study [J].
Nkomo, Vuyisile T. ;
Gardin, Julius M. ;
Skelton, Thomas N. ;
Gottdiener, John S. ;
Scott, Christopher G. ;
Enriquez-Sarano, Maurice .
LANCET, 2006, 368 (9540) :1005-1011
[9]   Impact of Coronary Artery Disease on 30-Day and 1-Year Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement: A Meta-Analysis [J].
Sankaramangalam, Kesavan ;
Banerjee, Kinjal ;
Kandregula, Krishna ;
Mohananey, Divyanshu ;
Parashar, Akhil ;
Jones, Brandon M. ;
Jobanputra, Yash ;
Mick, Stephanie ;
Krishnaswamy, Amar ;
Svensson, Lars G. ;
Kapadia, Samir R. .
JOURNAL OF THE AMERICAN HEART ASSOCIATION, 2017, 6 (10)
[10]   Elective or Emergency Use of Mechanical Circulatory Support Devices During Transcatheter Aortic Valve Replacement [J].
Singh, Vikas ;
Damluji, Abdulla A. ;
Mendirichaga, Rodrigo ;
Alfonso, Carlos E. ;
Martinez, Claudia A. ;
Williams, Donald ;
Heldman, Alan W. ;
De Marchena, Eduardo J. ;
O'Neill, William W. ;
Cohen, Mauricio G. .
JOURNAL OF INTERVENTIONAL CARDIOLOGY, 2016, 29 (05) :513-522