Transaortic TAVR and MICS-CABG in a Patient on Dialysis With RCA Restenosis.

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.