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Simultaneous hybrid off-pump coronary artery bypass grafting and transcatheter aortic valve implantation in elderly patients

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Abstract

Purpose

Optimal strategy for transcatheter aortic valve implantation (TAVI) in patients with coronary artery disease (CAD) is unresolved. We evaluated the surgical outcomes of hybrid coronary artery bypass grafting (CABG) and TAVI in elderly patients.

Methods

We retrospectively evaluated patients who underwent simultaneous TAVI and CABG at Wakayama Medical University, Japan. All patients underwent off-pump CABG (OPCAB) including minimally invasive cardiac surgery (MICS-CABG). In an earlier period, OPCAB + transfemoral TAVI (TF-TAVI) was the only method used, while in a later period, we introduced MICS-CABG and alternative approaches for TAVI.

Results

Twenty-seven patients were enrolled, the average age was 83.6 ± 5.1 years. In the MICS-CABG and TAVI group, average patient age was higher (87.0 ± 3.1 years) than in the earlier group. Thirty-day and in-hospital mortalities were zero. Incomplete revascularization rate was 33.3% and one patient required percutaneous coronary intervention after the operation. Graft patency rate was 100%. In MICS-CABG group, the number of distal anastomoses was smaller (1.29, range 1–2), but the number of days required to re-starting walking and postoperative hospital stay were shorter, and the rate of discharge to home was higher (100%) than in the other groups.

Conclusions

Although 33.3% of patients did not achieve complete revascularization, there was no 30-day or in-hospital mortality. TAVI and hybrid OPCAB, including MICS-CABG, were suggested to be feasible treatment in elderly patients.

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Acknowledgements

We acknowledge proofreading and editing by Benjamin Phillis at the Clinical Study Support Center at Wakayama Medical University.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University Hospital, 811-1, Kimiidera, Wakayama City, 641-8509, Japan

    Kentaro Honda, Hideki Kunimoto, Takahiro Fujimoto, Maiko Matsuda, Mizuho Ikuchi, Yoshiki Furuta, Kota Agematsu & Yoshiharu Nishimura

  2. Department of Cardiovascular Medicine, Wakayama Medical University Hospital, Wakayama City, Japan

    Teruaki Wada, Yasutsugu Shiono, Hironori Kitabata & Atsushi Tanaka

Authors
  1. Kentaro Honda
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  2. Teruaki Wada
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  3. Hideki Kunimoto
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  4. Takahiro Fujimoto
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  5. Maiko Matsuda
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  6. Mizuho Ikuchi
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  7. Yoshiki Furuta
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  8. Kota Agematsu
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  9. Yasutsugu Shiono
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  10. Hironori Kitabata
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  11. Atsushi Tanaka
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  12. Yoshiharu Nishimura
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Corresponding author

Correspondence to Kentaro Honda.

Ethics declarations

Ethical statement

This study was approved by the Institutional Review Board of Wakayama Medical University (No. 3620).

Human and animal rights statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Honda, K., Wada, T., Kunimoto, H. et al. Simultaneous hybrid off-pump coronary artery bypass grafting and transcatheter aortic valve implantation in elderly patients. Indian J Thorac Cardiovasc Surg 39, 570–576 (2023). https://doi.org/10.1007/s12055-023-01577-6

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  • DOI: https://doi.org/10.1007/s12055-023-01577-6

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