Surgical Update

Leacche, Marzia; Umakanthan, Ramanan; Zhao, David; Byrne, John G.

doi:10.1161/circinterventions.110.957951

Cited by 29 publications

(4 citation statements)

References 41 publications

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“…Leacche et al reported the outcomes of 39 high-risk patients who underwent PCI + MIMVS via a right thoracotomy (26). Of the 39 patients, 5 (13%) presented with acute coronary syndrome, 19 (49%) were in congestive heart failure, 16 (41%) underwent urgent or emergent surgery, and 16 (41%) were re-operations.…”

Section: Discussionmentioning

confidence: 99%

Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience

et al. 2017

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Background: The current study evaluated the safety and feasibility of staged ("hybrid") percutaneous coronary intervention (PCI) followed by isolated minimally invasive mitral valve (MV) surgery [PCI + minimally invasive mitral valve surgery (MIMVS)], for patients with concomitant coronary artery and MV disease. Results: There were 54 (58.1%) men and 39 (41.9%) women. The mean age was 73±8 years, and all patients had severe mitral regurgitation. PCI was performed for single-vessel coronary artery disease in 40 (43%) patients, two-vessel in 49 (52.7%), and three-vessel in 4 (4.3%). Within a median of 48 days (IQR, 18-71) after PCI, 78 (83.9%) patients underwent primary valve surgery, and 15 (16.1%) underwent re-operative valve surgery, with 56 (60.2%) having MV replacement, and 37 (39.8%) having MV repair.Sixty-five (69.9%) patients were being treated with dual anti-platelet therapy at the time of surgery. The median number of transfused intra-operative red blood cell units was 1 (IQR, 0-2), and the intensive care unit and hospital lengths of stay were 46 hours (IQR, 27-76) and 8 days (IQR, 5-11), respectively. Post-operatively, there was 1 (1.1%) cerebrovascular accident, 2 (2.2%) patients developed acute kidney injury, and 4 (4.3%) required a re-operation for bleeding. Thirty-day mortality occurred in 4 (4.3%) patients.At a mean follow-up of 15.3±13.2 months, 3 (3.4%) patients required target-vessel revascularization. The survival rate was 89% and 85% at 1 and 3 years, respectively. Conclusions:In patients with concomitant coronary artery and MV disease, PCI + MIMVS can be safely performed and is associated with good short-term and follow-up outcomes.

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Section: Discussionmentioning

confidence: 99%

Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience

et al. 2017

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“…These recommendations are understandable because the CABG procedure is favorable in patients who undergo sternotomy for the valve surgery and PCI is favorable in those who receive treatment percutaneously. Although previous reports have been published reporting favorable results of a hybrid concept consisting of PCI and MIMVS in different patient cohorts with mitral valve and coronary disease [11][12][13][14], there are no recommendations regarding the revascularization strategy in patients who might undergo MIMVS in the presence of adequate expertise.…”

Section: Discussionmentioning

confidence: 99%

Combined Minimally Invasive Mitral Valve Surgery and Percutaneous Coronary Intervention: A Hybrid Concept for Patients with Mitral Valve and Coronary Pathologies

Moscoso-Ludueña,

Vondran,

Irqsusi

et al. 2023

JCM

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We evaluated the feasibility of hybrid percutaneous coronary intervention (PCI) and minimally invasive mitral valve surgery (MIMVS) in patients with concomitant coronary and mitral disease. Of 534 patients who underwent MIMVS at our institution between 2012 and 2018, those with combined mitral and single vessel coronary pathologies who underwent MIMVS and PCI were included. Patients were excluded if they had endocarditis or required emergency procedures. Preprocedural, procedural, and postprocedural data were retrospectively analyzed. In total, 10 patients (median age, 75 years; 7 males) with a median ejection fraction (EF) of 60% were included. Nine patients underwent PCI before and one after MIMVS. The success rate was 100% in both procedures. There were no postoperative myocardial infarctions or strokes. Two patients developed delirium and one required re-thoracotomy for bleeding. The median stay in intensive care and the hospital was 3 and 8 days, respectively. The 30-day survival rate was 100%. A hybrid PCI and MIMVS approach is feasible in patients with mitral valve and single vessel coronary disease. In combined pathologies, the revascularization strategy should be evaluated independent from the mitral valve pathology in the presence of MIMVS expertise. Extension of this recommendation to multivessel disease should be evaluated in future studies.

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“…There was one non-cardiac in-hospital death, and no late mortality at a mean follow-up of 19 months. Some authors suggest that the benefits obtained from staging PCI and valve surgery are greater when a minimally invasive technique is utilized, in patients with an acute coronary syndrome, in those that have poor conduit or target-vessel quality, have left ventricular systolic dysfunction, and/or are undergoing re-operative cardiac surgery (23)(24)(25). With regards to MIVS, direct comparisons with combined CABG and valve surgery have associated PCI+MIVS with fewer adverse events and a faster postoperative recovery (12).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of a hybrid approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement

et al. 2017

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Background: In patients requiring coronary revascularization and aortic valve replacement, a combined approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement may be a viable treatment strategy.Methods: The outcomes of 123 consecutive patients with significant coronary artery and aortic valve disease, who underwent percutaneous coronary intervention followed by elective minimally invasive aortic valve replacement between February 2009 and April 2014, were retrospectively evaluated. Results:The cohort consisted of 80 males and 43 females, with a mean age of 75.7±8.1 years. Drug-eluting stents were used in 69.9% of the patients, and 64.2% were on dual anti-platelet therapy at the time of aortic valve replacement. Within a median of 39 days (IQR 21-64), 83.7% of the patients underwent primary and 16.3% underwent re-operative minimally invasive aortic valve replacement. Post-operatively, there was 1 (0.8%) cerebrovascular accident, 1 patient (0.8%) required a re-operation due to bleeding, and 2 (1.6%) developed acute kidney injury. Thirty-day mortality occurred in 2 (1.6%) patients. Follow-up was available for all of the patients, and at a mean follow-up period of 14.3±12.5 months, 4 (3.3%) had an acute coronary syndrome, and 1 (0.8%) required a repeat target vessel revascularization. The actuarial survival rate at 1-and 3-year was 92.7% and 89.4%, respectively. Conclusions:In a select group of patients with coronary artery and aortic valve disease, a combined approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement can be safely performed with excellent short-term and midterm outcomes.

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Surgical Update

Cited by 29 publications

References 41 publications

Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience

Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience

Combined Minimally Invasive Mitral Valve Surgery and Percutaneous Coronary Intervention: A Hybrid Concept for Patients with Mitral Valve and Coronary Pathologies

Outcomes of a hybrid approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement

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