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Background and Aim of Study: The treatment of inoperable patients with concomitant complex coronary artery disease and severe aortic stenosis unsuitable for conventional transcatheter aortic valve replacement (TAVR) poses a significant challenge. Effective treatment is even more difficult in those patients with complex coronary anatomy unamenable to percutaneous revascularization. Our manuscript aims to enlighten clinicians on the management of this complex patient., Methods: We conducted a contemporary review of the literature of combined off-pump coronary artery bypass grafting and transaortic TAVR in this patient population and describe our own successful experience in an inoperable patient with a porcelain aorta., Results: Including our report, 17 cases have been described in the literature. All patients had multiple comorbidities with elevated STS (range, 2.6-25; 6%) and EuroScore I (range, 13.7-83; 7%) and were not considered candidates for conventional CABG and SAVR. Most had severe, complex, multivessel CAD deemed unsuitable for PCI and structural findings precluding them from other standard percutaneous or alternative TAVR approaches (transfemoral/subclavian/transcaval/transapical). Out of the 17 cases, 5 (29%) had porcelain aortas. Most reports specify the decision-making process is driven by a multidisciplinary team., Conclusion: This report demonstrates that hybrid off-pump CABG surgery and transaortic TAVR can be successfully performed in high-risk patients with porcelain aortas who are not candidates for percutaneous methods, on-pump revascularization, transfemoral, subclavian, or transcaval valve implantations. It also highlights that careful study of the CTA scan could predict adequate access for a transaortic approach even in the presence of porcelain aorta in selected patients., (© 2019 Wiley Periodicals, Inc.)

We report a patient with a massive inferior vena cava (IVC) thrombus requiring immediate intervention. The patient underwent successful thrombectomy using a percutaneous catheter aspiration system. Percutaneous removal of an IVC thrombus is a safe and effective treatment option for severely ill patients., (© 2014 Wiley Periodicals, Inc.)

Tricuspid valve (TV) perforation is a rare complication after implantable cardioverter defibrillator (ICD) and permanent pacemaker implantation. In reported cases of lead-related TV perforations, patients' present with symptoms months to years postimplantation. We describe a case where a patient presented with signs of severe TV regurgitation secondary to traumatic perforation of the septal leaflet two weeks after ICD implantation and review of the literature associated with this complication., (© 2014 Wiley Periodicals, Inc.)

The use of the internal mammary artery (IMA) in myocardial revascularization has been expanded with bilateral and sequential grafting. However, its application in the presence of left main coronary artery stenosis (LMCAS) has not been well established. From September 1983 through December 1990, 280 patients with LMCAS greater than 50% were revascularized (3.4 mean grafts per patient) with bilateral IMA and saphenous vein grafts. Eighty-one were sequential IMA grafts. There were 234 males (83.6%) and 46 females (16.4%) with a mean age of 64.4 years (range 39 to 84 years). Preoperatively, there were six patients (2.1%) in New York Heart Association (NYHA) Class I, 30 patients (10.7%) in Class II, 130 patients (46.4%) in Class III, and 114 patients (40.7%) in Class IV. Fifty-six patients (20.0%) had an ejection fraction less than 50%. Intraaortic balloon counterpulsation was used preoperatively in 26 patients (9.3%) and intraoperatively in 11 patients (3.9%). There were four hospital deaths (1.4%). Hospital complications included: reoperation for bleeding, 7 patients (2.5%); pulmonary insufficiency, 21 patients (7.5%); perioperative infarction, 14 patients (5.0%); and stroke, 4 patients (1.4%). Follow-up was obtained in 276 hospital survivors (100.0%) with a mean of 33.4 months. There were 20 late deaths (7.1%): seven cardiac related and 12 noncardiac related. Postoperative assessment reveals substantial functional improvement. These results furnish evidence that bilateral IMA grafts can be accomplished with a low operative risk and can provide excellent functional results in patients with LMCAS.