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In this meta-analysis of contemporary RCTs, successful transcatheter closure of PFO might be more effective than medical therapy alone for the prevention of recurrent thromboembolic events.

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Introduction: A hybrid approach of PCI followed by minimally invasive valve surgery (MIVS) has been recently introduced as an alternative for patients with concomitant coronary artery and valvular heart disease. Hypothesis: A hybrid approach might be better than the conventional median sternotomy CABG plus valve surgery for such patients. Methods: We retrospectively evaluated 525 consecutive patients with concomitant coronary artery and valvular heart disease who underwent surgical intervention at our institution between January 2009 and April 2014. A propensity score matching was performed to adjust for differences between the hybrid and the conventional groups. Results: A total of 63 patients who underwent a hybrid approach were propensity score-matched with a cohort of 63 conventional approach patients. There were no differences in the baseline characteristics (Table). Most patients in the hybrid group had drug-eluting stents (83%) placed for single (44.4%) or dual (50.8%) vessel disease, and within a median of 40 days, underwent single (87%) or double (13%) valve surgery. There was no difference in the type of valve surgery between the groups. Post-operatively, patients in the hybrid group had significantly shorter intensive care unit length of stay, fewer packed red blood cell units transfused, and a decreased incidence of re-intubation, prolonged ventilation, and acute kidney injury. There was no difference between the groups in other post-operative complications, including cerebrovascular accidents, re-operation for bleeding, atrial fibrillation, and 30-day mortality. At long-term follow-up (mean 29 months) the overall all-cause mortality was 9.5%, and the Kaplan-Meier estimated 5-year survival rates were similar (85 vs 90%, p =0.45). Conclusions: A hybrid approach of PCI followed by MIVS is associated with a decreased morbidity, and similar short and long-term survival when compared with conventional median sternotomy CABG plus valve surgery.