Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation

Mihos, Christos G.; Xydas, Steve; Williams, Roy F.; Pineda, Andrés M.; Yucel, Evin; Davila, Hector; Beohar, Nirat; Santana, Orlando

doi:10.21037/jtd.2017.04.17

Cited by 4 publications

(5 citation statements)

References 18 publications

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“…20 Another retrospective study examined the outcomes of PCI and MV surgery performed on separate days. 18 It compared 24 consecutive patients, with 2-vessel coronary artery disease and moderate or severe ischemic MR, who had a PCI plus minimally invasive MV surgery versus the classic full sternotomy CABG plus MV surgery. There were 9 patients who had PCI and minimally invasive MV surgery, and the median time between PCI and subsequent MV surgery was 40 days.…”

Section: Staged Proceduresmentioning

confidence: 99%

“…Current literature contains observational studies that support the feasibility of a future randomized study. 18,19 One group reported a case series of 26 patients who underwent a same-day approach of PCI followed by open surgical MV repair in a hybrid operating room under one anesthetic. 19 This study did not detect any increased incidence of acute kidney injury (AKI), but other larger scale studies that retrospectively examined patients undergoing same-day coronary angiography and any cardiac surgery (ie, not just MV surgery) have demonstrated increased risk of AKI after intravenous contrast administration.…”

Section: Staged Proceduresmentioning

confidence: 99%

See 1 more Smart Citation

Ischemic Mitral Regurgitation: Repair, Replacement or Nothing

Nonaka

Fox

2018

Semin Cardiothorac Vasc Anesth

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The treatment strategy for ischemic mitral regurgitation (MR) continues to evolve with the completion of multicenter trials and the advancement of surgical and percutaneous interventional techniques. This review defines ischemic MR, outlines key clinical trials that assess surgical and interventional approaches, and reports the main elements of recent national guidelines for decision making in treatment of ischemic MR. New findings in percutaneous mitral valve repair and replacement for ischemic MR will also be described. Effective perioperative care of patients with ischemic MR requires clinicians to be well versed in the most up-to-date recommendations and emerging technological developments.

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Section: Staged Proceduresmentioning

confidence: 99%

Section: Staged Proceduresmentioning

confidence: 99%

Ischemic Mitral Regurgitation: Repair, Replacement or Nothing

Nonaka

Fox

2018

Semin Cardiothorac Vasc Anesth

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“…In the study of Mihos CG, et al (19), even though there was a higher use of pre-operative clopidogrel in those undergoing PCI+MIMVS, there were fewer intraoperative transfusions required, when compared with CABG+MVS. The lower need for blood products in the PCI+MIVS group is most likely due to the fact that, by its less traumatic nature, minimally invasive valve surgery is associated with less blood loss.…”

Section: Discussionmentioning

confidence: 91%

Comparison between Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft with Mitral Valve Replacement in Patients with Single Vessel and Mitral Valve Disease

Abdelmoiem¹,

Saber

Abass

et al. 2022

Preprint

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Background: We compared staged percutaneous coronary intervention (PCI) versus coronary artery bypass graft (CABG) with mitral valve replacement (MVR) in patients with combined single vessel and rheumatic mitral valve disease. Methods: We prospectively evaluated 80 patients with combined single coronary artery (requiring revascularization in non-LAD (Left Anterior Descending artery) territory) and rheumatic mitral valve disease, divided into two groups; Group I consisting of 40 patients who underwent staged PCI, and mitral valve replacement 3 months later, and Group II consisting of 40 patients who underwent combined CABG (using saphenous venous graft) and mitral valve replacement. We compared between both groups. Results: The median aortic cross-clamp and cardiopulmonary bypass times were 44 and 62 minutes for Group I, versus 60.5 and 82 minutes for Group II, that difference between groups is statistically significant. 8 patients (20%) in Group I needed inotropic support versus 12 patients (30%) in Group II, which is not statistically significant. No patients in both groups did need any mechanical support in the form of intra-aortic balloon pump (IABP). None of the patients in both groups had intraoperative ECG (electrocardiogram) changes in the form of ischemia or arrhythmias. The median intensive care unit (ICU) length of stay (hours) and hospital length of stay (days) were 39 hours and 5.5 days for Group I, versus 56.5 hours and 8.5 days for Group II, that difference between groups is statistically significant. The median blood loss (ml) postoperatively was 925 in group I versus 1075 in group II, which is statistically significant. However, the rate of re-exploration for bleeding did not differ significantly between both groups, with 1 case only (2.5%) in group I versus 2 cases (5%) in group II, and no postoperative delayed cardiac tamponade noted in any of the two groups. The post-operative complications for groups I and II included 0 (0%) versus 3 (7.5%) prolonged mechanical ventilation (>24 h), 0 (0%) versus 1 (2.5%) respiratory complications, 0 (0%) versus 2 (5%) wound infection, 0 (0%) versus 1 (2.5%) cerebrovascular accidents, 2 (5%) versus 1 (2.5%) acute kidney injury, respectively. There is no statistically significant difference between both groups regarding these previous post-operative complications. None of the patients in both groups died within the first 30 days after surgery. None of the patients in both groups had major cardiac events or CCU (Cardiac Care Unit) admission. Regional wall motion abnormalities were noted in 15 patients (37.5%) of group I versus 17 patients (42.5%) of group II, who all undergone stress ECG, of whom 9 patients (22.5%) in group I versus 11 patients (27.5%) in group II showed positive results, and qualified for diagnostic coronary angiography, which confirmed the need for reoperation for myocardial ischemia/infarction within the first year of follow up post-operatively in 4 patients (10%) of group I versus 8 patients (20%) of group II. All these follow up outcomes showed no significant difference between both groups. Conclusions: A staged approach of PCI followed by MVR is an alternative to the conventional combined CABG and MVR, can be performed safely in some patients with single coronary artery and MV disease, and is associated with good short and follow-up outcomes

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“…366 A study investigating the feasibility of minimally invasive mitral valve surgery after PCI in a small number of patients at a single center reported favorable results. 367,368 In Japan, a minimally-invasive percutaneous treatment for MR patients who are likely to undergo surgery (e.g., aged individuals) was added to the approved treatments of the National Health Insurance program in 2018. Clinical application of the treatment started immediately.…”

Section: ▋ 42 Pci ▋ 421 Aortic Stenosis (As; Table 21)mentioning

confidence: 99%