Work

One-Step Hybrid MIDCAB, Complex PCI, and TAVR in a 94-Year-Old Male With Early Cardiogenic Shock

Year: 2025

Type: article

Abstract: BACKGROUND: Management of a complex multivessel disease with concomitant severe aortic stenosis remains clinically challenging, particularly in high-risk elderly patients. CASE SUMMARY: We describe the first known case of a nonagenarian with acute coronary syndrome and early cardiogenic shock who underwent a one-step hybrid minimally invasive direct coronary artery bypass, percutaneous coronary intervention, and transcatheter aortic valve replacement. The procedure was challenging and required unplanned escalation to extracorporeal membrane oxygenation support but was successfully performed with durable results at 1-year follow-up. DISCUSSION: The constant evolution in the management of combined structural heart and coronary artery disease provides new opportunities for alternative hybrid approaches that may better address patients with challenging comorbidities and prohibitively high surgical risk. TAKE-HOME MESSAGES: Hybrid coronary revascularization with combined transcatheter aortic valve replacement is a viable alternative in unacceptably high surgical risk patients. This case highlights the crucial role of a multidisciplinary heart team to accomplish excellent short- and long-term durable results.

Source: JACC Case Reports

DOI: 10.1016/j.jaccas.2025.105671

Authors: Daniel Tran, Elio Rodriguez, Alexandra Tuluca, Christian Witzke

Institution: Jefferson Einstein Philadelphia Hospital

Language: English

Topic: Cardiac Valve Diseases and Treatments

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850