Simultaneous transaortic transcatheter aortic valve implantation and off-pump coronary artery bypass: An effective hybrid approach.
OPCAB
Tao-TAVI
hybrid procedure
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Apr 2021
Apr 2021
Historique:
received:
05
12
2020
accepted:
18
12
2020
pubmed:
26
1
2021
medline:
11
5
2021
entrez:
25
1
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1226-1231Informations de copyright
© 2021 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.
Références
Gilard M, Eltchaninoff H, Iung B, et al. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med. 2012;366(18):1705-1715.
Baumgartner H, Falk V, Bax JJ, et al. ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739-2791.
Goel SS, Ige M, Tuzcu EM, et al. Severe aortic stenosis and coronary artery disease-implications for management in the transcatheter aortic valve replacement era: a comprehensive review. J Am Coll Cardiol. 2013;62(1):1-10.
Neumann FJ, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. Kardiol Pol. 2018;76(12):1585-1664.
Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;70(2):252-289.
Beach JM, Mihaljevic T, Svensson LG, et al. Coronary artery disease and outcomes of aortic valve replacement for severe aortic stenosis. J Am Coll Cardiol. 2013;61(8):837-848.
Holzhey D, Mohr FW, Walther T, et al. Current results of surgical aortic valve replacement: insights from the German Aortic Valve Registry. Ann Thorac Surg. 2016;101(2):658-666.
Ramee S, Anwaruddin S, Kumar G, et al. The rationale for performance of coronary angiography and stenting before transcatheter aortic valve replacement: from the Interventional Section Leadership Council of the American College of Cardiology. JACC Cardiovasc Interv. 2016;9(23):2371-2375.
Kappetein AP, Feldman TE, Mack MJ, et al. Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial. Eur Heart J. 2011;32(17):2125-2134.
Kobayashi J, Tagusari O, Bando K, et al. Total arterial off-pump coronary revascularization with only internal thoracic artery and composite radial artery grafts. Heart Surg Forum. 2002;6(1):30-37.
Taggart DP, Thuijs DJFM, Di Giammarco G, et al. Intraoperative transit-time flow measurement and high-frequency ultrasound assessment in coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2020;159(4):1283-1292.
Bapat V, Attia R. Transaortic transcatheter aortic valve implantation: step-by-step guide. Semin Thorac Cardiovasc Surg. 2012;24:206-211.
Wendt D, Shehada S-E, Mourad F, et al. Transit time flow measurement and high frequency ultrasound epicardial imaging to guide coronary artery bypass surgery. J Cardiovasc Surg (Torino). 2019;60(2):245-250.
Kappetein AP, Head SJ, Généreux P, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg. 2013;145(1):6-23.
Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380:1695-1705.
Dewey TM, Brown DL, Herbert MA, et al. Effect of concomitant coronary artery disease on procedural and late outcomes of transcatheter aortic valve implantation. Ann Thorac Surg. 2010;89(3):758-767.
Elbaz GG, Henning KA, Qiu F, et al. Impact of coronary artery severity and revascularization prior to transcatheter aortic valve implantation. Am J Cardiol. 2020;125(6):924-930.
Gautier M, Pepin M, Himbert D, et al. Impact of coronary artery disease on indications for transcatheter aortic valve implantation and on procedural outcomes. EuroIntervention J Eur Collab with Work Gr Interv Cardiol Eur Soc Cardiol. 2011;7(5):549-555.
Wendt D, Kahlert P, Lenze T, et al. Management of high-risk patients with aortic stenosis and coronary artery disease. Ann Thorac Surg. 2013;95(2):599-605.
Masson J-B, Lee M, Boone RH, et al. Impact of coronary artery disease on outcomes after transcatheter aortic valve implantation. Catheter Cardiovasc Interv Off J Soc Card Angiogr Interv. 2010;76(2):165-173.
Goel SS, Agarwal S, Tuzcu EM, et al. Percutaneous coronary intervention in patients with severe aortic stenosis: implications for transcatheter aortic valve replacement. Circulation. 2012;125(8):1005-1013.
Ahad S, Wachter K, Rustenbach C, et al. Concomitant therapy: off-pump coronary revascularization and transcatheter aortic valve implantation. Interact Cardiovasc Thorac Surg. 2017;25(1):12-17.
Cheung A, Hon JKF, Ye J, Webb J. Combined off-pump transapical transcatheter aortic valve implantation and minimally invasive direct coronary artery bypass. J Card Surg. 2010;25(6):660-662.
Zubarevich A, Kadyraliev B, Arutyunyan V, et al. On-pump versus off-pump coronary artery bypass surgery for multi-vessel coronary revascularization. J Thorac Dis. 2020;12(10):5639-5646.
Bouchard D, Cartier R. Off-pump revascularization of multivessel coronary artery disease has a decreased myocardial infarction rate. Eur J Cardio-Thoracic Surg. 1998;14(Suppl 1):20-4S.
Prestipino F, Spadaccio C, Nenna A, et al. Off-pump coronary artery bypass grafting versus optimal medical therapy alone: effectiveness of incomplete revascularization in high risk patients. J Geriatr Cardiol. 2016;13(1):23-30.
Lorusso R, Moscarelli M, Di Franco A, et al. Association between coronary artery bypass surgical techniques and postoperative stroke. J Am Heart Assoc. 2019;8(24):e013650.
Van Mieghem NM, van der Boon RM, Faqiri E, et al. Complete revascularization is not a prerequisite for success in current transcatheter aortic valve implantation practice. JACC Cardiovasc Interv. 2013;6(8):867-875.
Kobayashi J, Shimahara Y, Fujita T, et al. Early results of simultaneous transaortic transcatheter aortic valve implantation and total arterial off-pump coronary artery revascularization in high-risk patients. Circ J. 2016;80(9):1946-1950.
Mayr B, Firschke C, Erlebach M, et al. Transcatheter aortic valve implantation and off-pump coronary artery bypass surgery: an effective hybrid procedure in selected patients. Interact Cardiovasc Thorac Surg. 2018;27(1):102-107.