Simultaneous Transaortic Transcatheter Aortic Valve Implantation and Off-Pump Coronary Artery Bypass Grafting for Stenosed Quadricuspid Aortic Valve: Case Report and Review of Literature

Abstract

Objective: Combinational hybrid therapies with transcatheter aortic valve implantation (TAVI), including simultaneous TAVI and off-pump coronary artery bypass (OPCAB), have become new options for patients with high surgical risk with severe aortic stenosis (AS) and concomitant coronary artery disease or other valvular disease. While quadricuspid aortic valve (QAV) is a rare congenital abnormality often associated with aortic regurgitation, only a small percentage of patients present with AS. Thus, the usefulness and technical features of TAVI for AS in QAV are not well established. We report a Japanese woman with a stenosed QAV and concomitant coronary artery disease, who was successfully treated by simultaneous transaortic TAVI and OPCAB.

Case presentation: An 86-year-old woman with multiple comorbidities presented with acute decompensated heart failure. Transthoracic echocardiography showed severe AS, and the patient was noticed to have QAV by preoperative computed tomography (CT) and transesophageal echocardiography. Coronary angiography revealed multiple coronary artery stenoses in the left main trunk, left anterior descending, and right coronary arteries. She was successfully treated by simultaneous transaortic TAVI and OPCAB using a 26-mm CoreValve.

Conclusion: We report a case of stenosed QAV with concomitant coronary artery disease and high surgical risk, successfully treated by simultaneous transaortic TAVI and OPCAB. TAVI for AS in QAV, as well as combinational hybrid therapies with TAVI, may be reasonable options for patients with high surgical risk.