<p>Patients with coronary artery disease undergoing trans-catheter aortic valve implantation (TAVI) often receive TAVI alone. However, in cases of severe coronary lesions or anticipated difficulty in coronary access post-TAVI, percutaneous coronary intervention or coronary artery bypass grafting may be necessary. We performed simultaneous gastroepiploic artery to posterior descending artery bypass and TAVI in two patients with severe calcification of the right coronary artery ostium which is unsuitable for percutaneous intervention. The procedure was conducted through an upper median laparotomy, avoiding a full sternotomy. Patients were discharged on postoperative days 6 and 9, respectively. By combining minimally invasive techniques and avoiding median sternotomy, we achieved favorable outcomes without compromising the less invasive nature of TAVI. This approach demonstrates the potential for tailored, hybrid procedures in high-risk patients with concomitant aortic valve disease and complex coronary lesions.</p>