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.