Simultaneous transcatheter aortic valve implantation and off-pump coronary artery bypass grafting for Takayasu arteritis

We report a patient who underwent simultaneous transcatheter aortic valve implantation and off-pump coronary artery bypass grafting for Takayasu arteritis with diffuse porcelain aorta. The patient was a 59-year-old female with severe aortic stenosis and regurgitation, as well as both coronary ostial stenosis and porcelain aorta. Bilateral internal thoracic arteries were unavailable due to Takayasu arteritis. Therefore, composite radial artery with in-situ gastroepiploic artery was used as graft material. Radial artery was anastomosed to left anterior descending artery and posterior descending artery sequentially. Surgical procedures were successfully accomplished and major perioperative complications did not occur. <Learning objective: Takayasu arteritis is a rare disease with vasculitis of aorta and its main branches. In addition, it is associated with a low incidence of coronary ostial stenosis and coronary ischemia can be fatal. Porcelain aorta with aortic valve lesion also complicates with Takayasu arteritis and it makes difficult to perform cardiac surgery. The optimal surgical strategy and process for those who combined with coronary ostial stenosis, aortic valve lesion and porcelain aorta remains a subject of debate.>.