Clinical & Medical Case Reports in Cardiology

Transapical aortic valve implantation (TAVIs) have become an established alternative to conventional aortic valve replacement in elderly high to intermediate risk patients. The main access is transfemoral; alternatively transapical, transaortic and other rare vascular approaches are used. Some patients however, are present with severe comorbidities, which necessitate further considerations. We will present two such patients. The first patient, 81 years of age, had severe bilateral carotid artery disease with status post stroke together with significant aortic stenosis. We choose to perform a bilateral carotid endarterectomy and in the operation also a transcarotid catheter guided aortic valve implantation via a vascular graft attached to the left common carotid artery. The second patient was referred to us for a TAVI, but heart catheterization revealed a filiform left main stem stenosis. We decided to perform an on pump double CABG and a direct transaortic TAVI through a mini aortotomy. By this hybrid approach, x–clamp time was really minimized and the 91 year old patient had an uneventful course as well. Since then we have performed a small series of such hybrid interventions.