Discussion
Combined ONCAB and SAVR remains the treatment of choice for patients
presenting with extensive coronary artery disease and concomitant aortic
stenosis. In our study, we utilized a novel entirely anaortic approach
by performing concomitant anaortic OPCAB and transfemoral TAVR. We
achieved excellent results in a hitherto prohibitive operative risk
cohort attributed to their porcelain aortas, demonstrating feasibility
and efficacy of this combined technique. We propose this hybrid
technique in patients who have severe coronary artery disease not
amenable to PCI , aortic stenosis requiring intervention, and where the
aortic calcific burden prevents aortic cross-clamping or where aortic
manipulation or cardiopulmonary bypass would pose undue risk to the
patient.