An 86-year-old woman with severe aortic stenosis was thought to be at a high risk for surgical aortic valve replacement and inoperability due to old age and porcelain aorta. Furthermore, transcatheter aortic valve replacement (TAVR) was considered difficult due to high risk of coronary obstruction secondary to the aortic root anatomy and poor vascular access associated with marked atherosclerotic lesions on the distal aortic arch with peripheral artery disease. We successfully treated her with TAVR via the brachiocephalic artery in combination with prophylactic off-pump coronary artery bypass grafting.
Keywords: Aortic stenosis; Low origin of the coronary arteries; Off-pump coronary artery bypass grafting; Porcelain aorta; Transcatheter aortic valve replacement.
© 2021. The Japanese Association for Thoracic Surgery.