JACC. Case reports · 2026
Transaortic TAVR and MICS-CABG in a Patient on Dialysis With RCA Restenosis.
Клинический случайСтатьяНазвание и аннотация: Перевод пока не подготовлен
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Sai Yoshun, Kikuchi Keita, Sakai Hiroki, Yoshino Kunihiko, Noguchi Masahiko, Ito Joji
Аннотация
BACKGROUND: Severe aortic stenosis in patients undergoing dialysis often coexists with diffuse vascular and coronary calcifications, complicating access and revascularization.
CASE SUMMARY: A man in his 80s undergoing maintenance hemodialysis presented with heart failure and dialysis intolerance. Echocardiography revealed severe aortic stenosis, coronary angiography showed 99% ostial right coronary artery in-stent restenosis, and computed tomography demonstrated a shaggy descending aorta with unsuitable transfemoral and nonfemoral access routes but a relatively preserved ascending aorta. The heart team performed simultaneous transaortic transcatheter aortic valve replacement and minimally invasive coronary artery bypass grafting using a saphenous vein graft to the posterior descending artery. A 29-mm Evolut FX (Medtronic) valve was successfully implanted.
DISCUSSION: This strategy avoided sternotomy, cardiopulmonary bypass, hostile peripheral access, and repeat ostial percutaneous coronary intervention.
TAKE-HOME MESSAGE: Simultaneous transaortic transcatheter aortic valve replacement and minimally invasive coronary artery bypass grafting may be useful when standard access and durable percutaneous coronary intervention are unsuitable.
CASE SUMMARY: A man in his 80s undergoing maintenance hemodialysis presented with heart failure and dialysis intolerance. Echocardiography revealed severe aortic stenosis, coronary angiography showed 99% ostial right coronary artery in-stent restenosis, and computed tomography demonstrated a shaggy descending aorta with unsuitable transfemoral and nonfemoral access routes but a relatively preserved ascending aorta. The heart team performed simultaneous transaortic transcatheter aortic valve replacement and minimally invasive coronary artery bypass grafting using a saphenous vein graft to the posterior descending artery. A 29-mm Evolut FX (Medtronic) valve was successfully implanted.
DISCUSSION: This strategy avoided sternotomy, cardiopulmonary bypass, hostile peripheral access, and repeat ostial percutaneous coronary intervention.
TAKE-HOME MESSAGE: Simultaneous transaortic transcatheter aortic valve replacement and minimally invasive coronary artery bypass grafting may be useful when standard access and durable percutaneous coronary intervention are unsuitable.