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.