Transcatheter aortic valve replacement in patients undergoing robotic totally endoscopic coronary artery bypass: A case series
Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9510675/
Transcatheter aortic valve replacement (TAVR) has been utilized to treat patients with symptomatic aortic stenosis (AS). Recent trials suggest comparable efficacy compared to surgical aortic valve replacement (SAVR). Robotic off-pump totally endoscopic coronary artery bypass graft surgery (TECAB) had been shown to be a minimally invasive revascularization strategy with clinical results comparable to traditional coronary artery bypass graft surgery (CABG).
Conclusion/Relevance: Since patients with severe aortic stenosis are at high risk of developing cardiac arrest and cardiogenic shock upon induction of anesthesia, the ability to treat severe symptomatic AS with TAVR under conscious sedation prior to TECAB can be considered as a safe an effective treatment.
• Source: Frontiers in Cardiovascular Medicine
• Conclusion/Relevance: “The case series demonstrates a hybrid approach that offers complete sternotomy sparing cardiovascular care to treat severe symptomatic AS and CAD. Since patients with severe aortic stenosis are at high risk of developing cardiac arrest and cardiogenic shock upon induction of anesthesia, the ability to treat severe symptomatic AS with TAVR under conscious sedation prior to TECAB [robotic off-pump totally endoscopic coronary artery bypass graft surgery] can be considered as a safe an effective treatment.”
• University of Chicago Medicine, where this case series was performed, is a referral center for robotic heart surgery and proffers single and multivessel totally endoscopic all-arterial revascularization.
• This approach in CAD and AS patients allows for the safe completion of TAVR before coronary revascularization. Patients returned to baseline activities within a few weeks of each procedure and experienced symptomatic improvement. The patients will be followed up for clinical efficacy and safety.
• This hybrid strategy is minimally invasive and appropriate for patients with AS and CAD who are not candidates for percutaneous revascularization. The benefits include early discharge and recovery. Further studies are required to “not only elucidate the role of coronary revascularization prior to TAVR/SAVR, but also to investigate the hybrid role of TAVR and TECAB.”