{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:34:37Z","timestamp":1787762077628,"version":"build-2784847793"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>In this article, we present our initial clinical experience with staged minimally invasive direct coronary bypass (MIDCAB), percutaneous coronary intervention (PCI), and transcatheter aortic valve implantation (TAVI) in high-risk octogenarians (Hybrid).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The use of percutaneous techniques for managing structural heart diseases, especially in elderly high-risk patients, has revolutionized the treatment of structural heart diseases. These procedures are present predominantly being offered as isolated interventions. The feasibility, clinical benefit, and outcomes of combining these techniques with MIDCAB have not been sufficiently explored and have subsequently been underreported in the contemporary literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Four consecutive octogenarians with severe aortic stenosis (AS) and complex coronary artery disease (CAD) that were at high risk for conventional surgery with extracorporeal circulation (ECC) were discussed in our Multidisciplinary Heart Team (MDH). Our MDH consisted of an interventional cardiologist, cardiac surgeon, and cardiac anesthesiologist. A hybrid approach with the alternative strategy comprising of MIDCAB, PCI, and TAVI in a staged fashion was agreed on. All 4 patients had both PCI\/stenting and MIDCAB prior to deployment of the TAVI-prosthesis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>From January 2019 to December 2020, 4 consecutive patients aged between 83 and 85 (3 male\/1 female) years were scheduled for MIDCAB\/PCI followed by percutaneous treatment of severe symptomatic AS. Intraoperatively, one patient was converted to full sternotomy, and surgery was performed by off-pump coronary artery bypass grafting. The overall procedural success rate was 100% in all 4 patients with resolution of their initial presenting cardiopulmonary symptoms. There were no severe complications associated with all hybrid procedures. There was no 30-day mortality in all patients. All patients were discharged home with a median hospital stay ranging between 9 and 25 days. All patients have since then been followed-up regularly. There was one noncardiac-related mortality at 6-months postsurgery. All other patients were well at 1-year follow-up with improved New York Heart Association Class II.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In a selected group of elderly, high prohibitive risk patients with CAD and severe symptomatic AS, a staged approach with MIDCAB and PCI followed by TAVI can be safely performed with excellent outcomes. We advocate a MDH-based preliminary evaluation of this patient cohort in selecting suitable patients and appropriate timing of each stage of the hybrid procedure.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aca.aca_165_21","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T03:00:23Z","timestamp":1687230023000},"page":"143-148","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Minimally Invasive Direct Coronary Artery Bypass and Percutaneous Coronary Intervention Followed by Transcatheter Aortic Valve Implantation: A Promising Concept in High-risk Octogenarians"],"prefix":"10.4103","volume":"26","author":[{"given":"Anthony","family":"Alozie","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alper","family":"\u00d6ner","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Heart Centre Rostock, University of Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"L\u00f6ser","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, University of Rostock, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascal M.","family":"Dohmen","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Heart Centre Rostock, University of Rostock, Germany"},{"name":"Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State Bloemfontein, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"key":"R1-20240901","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1016\/j.jtcvs.2020.04.171","article-title":"Minimally invasive coronary bypass versus percutaneous coronary intervention for isolated complex stenosis of the left anterior descending coronary artery","volume":"163","author":"Patel","year":"2022","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R2-20240901","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1016\/j.jtcvs.2017.10.135","article-title":"Off-pump versus on-pump coronary artery bypass grafting:Insights from the Arterial Revascularization Trial","volume":"155","author":"Benedetto","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"R3-20240901","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1177\/1076029616651146","article-title":"A Snapshot of coagulopathy after cardiopulmonary bypass","volume":"22","author":"H\u00f6fer","year":"2016","journal-title":"Clin Appl Thromb Hemost"},{"key":"R4-20240901","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/0003-4975(93)91048-R","article-title":"Inflammatory response to cardiopulmonary bypass","volume":"55","author":"Butler","year":"1993","journal-title":"Ann Thorac Surg"},{"key":"R5-20240901","doi-asserted-by":"crossref","first-page":"e0238880","DOI":"10.1371\/journal.pone.0238880","article-title":"Off-pump versus on-pump coronary artery surgery in octogenarians (from the KROK Registry)","volume":"15","author":"Knapik","year":"2020","journal-title":"PLoS One"},{"key":"R6-20240901","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jacc.2013.01.096","article-title":"Severe aortic stenosis and coronary artery disease\u2014Implications for management in the transcatheter aortic valve replacement era:A comprehensive review","volume":"62","author":"Goel","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"R7-20240901","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1007\/s00380-019-01519-6","article-title":"Does additional coronary artery bypass grafting to aortic valve replacement in elderly patients affect the early and long-term outcome?","volume":"35","author":"Formica","year":"2020","journal-title":"Heart Vessels"},{"key":"R8-20240901","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1093\/ejcts\/ezt242","article-title":"Early and mid-term outcomes of combined aortic valve replacement and coronary artery bypass grafting in elderly patients","volume":"45","author":"Fukui","year":"2014","journal-title":"Eur J Cardiothorac Surg"},{"key":"R9-20240901","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1111\/j.1532-5415.2011.03563.x","article-title":"Analysis of early and late outcomes after concomitant aortic valve replacement and coronary artery bypass graft surgery in octogenarians:A multi-institutional Australian study","volume":"59","author":"Saxena","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"R10-20240901","first-page":"e35","article-title":"2020 ACC\/AHA guideline for the management of patients with valvular heart disease:A Report of the American College of Cardiology\/American Heart Association Joint Committee on clinical practice guidelines","volume":"143","author":"Otto","year":"2021","journal-title":"Circulation"},{"key":"R11-20240901","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1111\/jocs.14814","article-title":"Coronary revascularization during treatment of severe aortic stenosis:A meta-analysis of the complete percutaneous approach (PCI plus TAVR) versus the complete surgical approach (CABG plus SAVR)","volume":"35","author":"Tarus","year":"2020","journal-title":"J Card Surg"},{"key":"R12-20240901","doi-asserted-by":"crossref","first-page":"S1334","DOI":"10.1016\/S0003-4975(02)03971-1","article-title":"Primary stenting versus MIDCAB:Preliminary report-comparision of two methods of revascularization in single left anterior descending coronary artery stenosis","volume":"74","author":"Cisowski","year":"2002","journal-title":"Ann Thorac Surg"},{"key":"R13-20240901","doi-asserted-by":"crossref","first-page":"4419","DOI":"10.1111\/jocs.15967","article-title":"Hybrid approach for percutaneous mitral valve repair (MitraClip\u00ae) followed by minimally invasive direct coronary artery bypass (MIDCAB) in a patient with a high risk constellation","volume":"36","author":"\u00d6ner","year":"2021","journal-title":"J Card Surg"},{"key":"R14-20240901","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1186\/s13019-021-01541-8","article-title":"Frailty and pre-frailty in cardiac surgery:A systematic review and meta-analysis of 66,448 patients","volume":"16","author":"Lee","year":"2021","journal-title":"J Cardiothorac Surg"},{"key":"R15-20240901","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1080\/14017431.2019.1644366","article-title":"30-day mortality in frail patients undergoing cardiac surgery:The results of the frailty in cardiac surgery (FICS) Copenhagen study","volume":"53","author":"B\u00e4ck","year":"2019","journal-title":"Scand Cardiovasc J"},{"key":"R16-20240901","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1093\/icvts\/ivy014","article-title":"Transcatheter aortic valve implantation and off-pump coronary artery bypass surgery:an effective hybrid procedure in selected patients","volume":"27","author":"Mayr","year":"2018","journal-title":"Interact Cardiovasc Thorac Surg"},{"key":"R17-20240901","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1053\/j.jvca.2013.07.020","article-title":"Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery","volume":"28","author":"Biancari","year":"2014","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"R18-20240901","doi-asserted-by":"crossref","first-page":"653768","DOI":"10.3389\/fcvm.2021.653768","article-title":"Percutaneous coronary intervention in transcatheter aortic valve implantation patients:Overview and practical management","volume":"8","author":"Weferling","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"R19-20240901","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1093\/ejcts\/ezab389","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"60","author":"Vahanian","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"R20-20240901","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur Heart J"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_165_21","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T16:14:36Z","timestamp":1787760876000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_165_21"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4]]},"references-count":20,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_165_21","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4]]},"assertion":[{"value":"2021-11-06","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-06","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}