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TA-TAVI And Concomitant CABG Operation Strategy What Should Be Done First?
Marie-Elisabeth Stelzmüller1, Sigrid Sandner2, Bruno Mora2, Günther Laufer2, Wilfried Wisser2.
1Medical University Vienna, vienna, Austria, 2Medical University Vienna, Vienna, Austria.

Objective: Patients with severe aortic sclerosis, severe coronary artery disease and aortic valve stenosis represent a very high risk patient cohort. This case series presents the experience of three TAVI and CABG procedures with different operation strategies. What should be done first, CABG or TAVI? Method: Between 2008 and 2013 three patients (1 woman, 2 men, mean age 74 years) with severe aortic stenosis and aortic sclerosis, as well as severe CAD were rejected for conventional surgery and referred for TAVI and CABG. The mean log Euroscore was 21.83% and Euroscore II 4.3%. In two patients TA-TAVI was performed prior to sternotomy and CABG. In the remaining patient we performed the sternotomy for CABG procedure prior to TA-TAVI (lateral thoracotomy). Mean procedure time was 423 min. Result: Performing TA-TAVI prior to CABG procedures was successful in both patients. CABG anastomosis could be performed without any complications. Luxation of the heart for CABG anastomosis did not lead to a dislocation of the implanted valve or lead to an increase of paravalvular insufficiency. Otherwise we could observe a significant longer operation time in case of performing CABG prior to TA-TAVI, because of difficulties in adjustment of the apex and performing valve implantation after sternotomy. Conclusion: Concomitant TA-TAVI procedure and CABG represents an excellent option for high risk patients with aortic sclerosis. TA-TAVI prior to CABG is recommendable due to the superiority of adjustment of the TAV via lateral thoracotomy and the resulting shorter operation time.

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