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Spiliopoulos K, Magouliotis D, Angelis I, Skoularigis J, Kemkes BM, Salemis NS, Athanasiou T, Gansera B, Xanthopoulos AV. Concomitant Valve Replacement and Coronary Artery Bypass Grafting Surgery: Lessons from the Past, Guidance for the Future? A Mortality Analysis in 294 Patients. J Clin Med 2023; 13:238. [PMID: 38202244 PMCID: PMC10780271 DOI: 10.3390/jcm13010238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/24/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE The aims of this study were to analyze parameters influencing early and late mortality after concomitant valve replacement and coronary artery bypass grafting surgery, using early and long-term information from an institutionally available data registry, and to discuss the results in relation to the current treatment strategies and perspectives. METHODS The study population consisted of 294 patients after combined valve replacement with mechanical prosthesis and CABG surgery. RESULTS There were 201 men (68.4%) and 93 women (31.6%). Concurrent to the coronary artery bypass grafting, 238 patients (80.9%) underwent aortic-, 46 patients (15.6%) mitral- and 10 patients (3.4%) doublevalve replacement. Cumulative duration of follow up was 1007 patient-years (py) with a maximum of 94 months and was completed in 92.2% (271 cases). Overall hospital mortality (30 days) rate was 6.5% (n = 19). It was significantly higher in patients of female gender, older than 70 y, in those suffering preoperative myocardial infarction, presenting with an additive EuroScore > 8 and being hemodynamically unstable after the operation. Cumulative survival rate at 7.6 y was 78.6%. Determinants of prolonged survival were male gender, age at operation < 70 y, preoperative sinus rhythm, normal renal function, additive EuroScore < 8 and the use of internal thoracic artery for grafting. Subsequent multivariate analysis revealed preoperative atrial fibrillation (HR: 2.1, 95% CI: 0.82-5.44, p: 0.01) and risk group of ES > 8 (HR: 3.63, 95% CI: 1.45-9.07, p < 0.01) as independent predictors for lower long-term survival. CONCLUSIONS Hospital mortality (30 d) was nearly 2.5-fold higher in female and/or older than 70 y patients. Preoperative atrial fibrillation and/ or a calculated ES > 8 were independent predisposing factors of late mortality for combined VR and CABG surgery. Tailoring the approach, with the employment of the newest techniques and hybrid procedures, to the individual patient clinical profile enables favorable outcomes for concomitant valvular disease and CAD, especially in high-risk patients.
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Affiliation(s)
- Kyriakos Spiliopoulos
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - Dimitrios Magouliotis
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
| | - Ilias Angelis
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - John Skoularigis
- Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (J.S.); (A.V.X.)
| | - Bernhard M. Kemkes
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | | | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (D.M.); (T.A.)
| | - Brigitte Gansera
- Department of Cardiovascular Surgery, Klinikum Bogenhausen, 81925 Munich, Germany (B.G.)
| | - Andrew V. Xanthopoulos
- Department of Cardiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41500 Larissa, Greece; (J.S.); (A.V.X.)
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Hasde AI, Sarıcaoğlu MC, Kılıçkap M, Durdu MS. Single or Combined Valve Surgery and Concomitant Right Coronary Artery Bypass through Right Anterior Minithoracotomy Approach. Thorac Cardiovasc Surg 2023; 71:614-619. [PMID: 35135024 PMCID: PMC10695698 DOI: 10.1055/s-0041-1731284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patients with combined valve and coronary artery disease are commonly performed by standard median sternotomy approach for coronary artery bypass grafting (CABG) and valve surgery. The purpose of this study is to describe our experience and show feasibility and safety of minimally invasive approach to single or combined valve pathology with single-vessel right coronary artery (RCA) disease, even if it is suitable to percutaneous coronary intervention. METHODS This retrospective study comprised 28 consecutive patients who underwent single or combined valve surgery concomitant right CABG through right anterior minithoracotomy between February 2018 and December 2020. Preoperative evaluation, intraoperative, and postoperative outcomes were reviewed and analyzed. RESULTS There were 12 men and 16 women. The mean age was 71.46 ± 6.82 years. Ten patients were in New York Heart Association class III or IV. The mean cardiopulmonary bypass and aortic cross-clamping times were 117.6 ± 21.3 and 98.1 ± 22.6 minutes, respectively. The mean time to extubation was 9.7 ± 5.6 hours, the mean intensive care unit stay was 37.4 ± 14.6 hours, and the mean hospital stay was 6.9 ± 3.2 days. There was one patient who underwent reoperation for bleeding. There were no instances of postoperative stroke, myocardial infarction, renal failure, or wound infection. The mean follow-up was 19 ± 2.4 months. CONCLUSION Presence of RCA lesion is not a contraindication for minimally invasive approach in cases who underwent single or combined valve surgery. Combined valve surgery and right CABG via right anterior minithoracotomy are a safe and feasible option to standard median sternotomy surgery, even if RCA lesions seem suitable for stenting.
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Affiliation(s)
- Ali Ihsan Hasde
- Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey
| | - Mehmet Cahit Sarıcaoğlu
- Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Kılıçkap
- Department of Cardiology, Heart Center, Ankara University School of Medicine, Ankara, Turkey
| | - Mustafa Serkan Durdu
- Department of Cardiovascular Surgery, Heart Center, Ankara University School of Medicine, Ankara, Turkey
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Fudulu DP, Layton GR, Nguyen B, Sinha S, Dimagli A, Guida G, Abbasciano R, Viviano A, Angelini GD, Zakkar M. Trends and outcomes of concomitant aortic valve replacement and coronary artery bypass grafting in the UK and a survey of practices. Eur J Cardiothorac Surg 2023; 64:ezad259. [PMID: 37462523 PMCID: PMC10580967 DOI: 10.1093/ejcts/ezad259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/03/2023] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVES Concomitant revascularization of coronary artery disease at the same time as treatment for aortic valvopathy favourably impacts survival. However, combined surgery may be associated with increased adverse outcomes compared to aortic valve replacement (AVR) or coronary artery bypass grafting in isolation. METHODS We retrospectively analyzed all patients who underwent AVR with bypass grafting between February 1996 and March 2019 using data from the National Adult Cardiac Surgery Audit. We used a generalized mixed-effects model to assess the effect of the number and type of bypass grafts associated with surgical AVR on in-hospital mortality, postoperative stroke, and the need for renal dialysis. Furthermore, we conducted an international cross-sectional survey of cardiac surgeons to explore their views about concomitant AVR with coronary bypass grafting interventions. RESULTS Fifty-one thousand two hundred and seventy-two patients were included in the study. Patients receiving 2 or more bypass grafts demonstrated more significant preoperative comorbidity and disease severity. Patients undergoing 2 and >2 grafts in addition to AVR had increased mortality as compared to patients undergoing AVR and only 1 graft [odds ratio (OR) 1.17, 95% confidence interval (CI) [1.05-1.30], P = 0.005 and OR 1.15, 95% CI [1.02-1.30], P = 0.024 respectively]. A single arterial conduit was associated with a reduction in mortality (OR 0.75, 95% CI [0.68-0.82], P < 0.001) and postoperative dialysis (OR 0.87, 95% CI [0.78-0.96], P = 0.006), but this association was lost with >1 arterial conduit. One hundred and three surgeons responded to our survey, with only a small majority believing that the number of bypass grafts can influence short- or long-term postoperative outcomes in these patients, and an almost equal split in responders supporting the use of staged or hybrid interventions for patients with concomitant pathology. CONCLUSIONS The number of grafts performed during combined AVR and coronary artery bypass grafting is associated with increased morbidity and mortality. The use of an arterial graft was also associated with reduced mortality. Future studies are needed to assess the effect of incomplete revascularization and measure long-term outcomes. Based on our data, current published evidence, and the collective expert opinion we gathered, we endorse future work to investigate the short and long-term efficacy and safety of hybrid intervention for patients with concomitant advanced coronary and aortic valve disease.
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Affiliation(s)
- Daniel P Fudulu
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Georgia R Layton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiac Surgery, University Hospitals of Leicester, Leicester, UK
| | - Bao Nguyen
- Department of Cardiac Surgery, Derriford Hospital, Plymouth, UK
| | - Shubhra Sinha
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Gustavo Guida
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Riccardo Abbasciano
- Department of Cardiac Surgery, Imperial College, Hammersmith Hospital, London, UK
| | - Alessandro Viviano
- Department of Cardiac Surgery, Imperial College, Hammersmith Hospital, London, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Mustafa Zakkar
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- Department of Cardiac Surgery, University Hospitals of Leicester, Leicester, UK
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Belur AD, Solankhi N, Sharma R. Management of coronary artery disease in patients with aortic stenosis in the era of transcatheter aortic valve replacement. Front Cardiovasc Med 2023; 10:1139360. [PMID: 37408653 PMCID: PMC10318168 DOI: 10.3389/fcvm.2023.1139360] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Aortic stenosis (AS) is a common valve disorder among the elderly, and these patients frequently have concomitant coronary artery disease (CAD). Risk factors for calcific AS are similar to those for CAD. Historically, the treatment of these conditions involved simultaneous surgical replacement of the aortic valve (AV) with coronary artery bypass grafting. Since the advancement of transcatheter AV therapies, there have been tremendous advancements in the safety, efficacy, and feasibility of this procedure with expanding indications. This has led to a paradigm shift in our approach to the patient with AS and concomitant CAD. Data regarding the management of CAD in patients with AS are largely limited to single-center studies or retrospective analyses. This article aims to review available literature around the management of CAD in patients with AS and assist in the current understanding in approaches toward management.
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Affiliation(s)
- Agastya D. Belur
- Cardiovascular Disease Fellowship Program, University of Louisville School of Medicine, Louisville, KY, United States
| | - Naresh Solankhi
- Jewish Hospital Cardiology, University of Louisville Jewish Hospital, Louisville, KY, United States
| | - Ravi Sharma
- Jewish Hospital Cardiology, University of Louisville Jewish Hospital, Louisville, KY, United States
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Dhingra NK, Verma S, Yanagawa B, Hibino M. Complete transcatheter versus complete surgical management for combined aortic stenosis and coronary artery disease: A false dichotomy? J Card Surg 2022; 37:2084-2085. [DOI: 10.1111/jocs.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Nitish K. Dhingra
- Division of Cardiac Surgery, St. Michael's Hospital University of Toronto Toronto Ontario Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital University of Toronto Toronto Ontario Canada
| | - Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital University of Toronto Toronto Ontario Canada
| | - Makoto Hibino
- Division of Cardiac Surgery, St. Michael's Hospital University of Toronto Toronto Ontario Canada
- Division of Cardiac Surgery, Harrington Heart and Vascular Institute University Hospitals Cleveland Medical Center Cleveland Ohio USA
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Patel KP, Michail M, Treibel TA, Rathod K, Jones DA, Ozkor M, Kennon S, Forrest JK, Mathur A, Mullen MJ, Lansky A, Baumbach A. Coronary Revascularization in Patients Undergoing Aortic Valve Replacement for Severe Aortic Stenosis. JACC Cardiovasc Interv 2021; 14:2083-2096. [PMID: 34620388 DOI: 10.1016/j.jcin.2021.07.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/25/2021] [Accepted: 07/27/2021] [Indexed: 01/09/2023]
Abstract
Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist, with up to two thirds of patients with AS having significant CAD. Given the challenges when both disease states are present, these patients require a tailored approach diagnostically and therapeutically. In this review the authors address the impact of AS and aortic valve replacement (AVR) on coronary hemodynamic status and discuss the assessment of CAD and the role of revascularization in patients with concomitant AS and CAD. Remodeling in AS increases the susceptibility of myocardial ischemia, which can be compounded by concomitant CAD. AVR can improve coronary hemodynamic status and reduce ischemia. Assessment of the significance of coexisting CAD can be done using noninvasive and invasive metrics. Revascularization in patients undergoing AVR can benefit certain patients in whom CAD is either prognostically or symptomatically important. Identifying this cohort of patients is challenging and as yet incomplete. Patients with dual pathology present a diagnostic and therapeutic challenge; both AS and CAD affect coronary hemodynamic status, they provoke similar symptoms, and their respective treatments can have an impact on both diseases. Decisions regarding coronary revascularization should be based on understanding this complex relationship, using appropriate coronary assessment and consensus within a multidisciplinary team.
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Affiliation(s)
- Kush P Patel
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Michael Michail
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Thomas A Treibel
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Krishnaraj Rathod
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Daniel A Jones
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Mick Ozkor
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Simon Kennon
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - John K Forrest
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Anthony Mathur
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Michael J Mullen
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Alexandra Lansky
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andreas Baumbach
- Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom; Yale University School of Medicine, New Haven, Connecticut, USA.
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7
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Pradegan N, D'Onofrio A, Longinotti L, Evangelista G, Mastro F, Fiocco A, Nadali M, Gerosa G. Feasibility of percutaneous coronary intervention before mitral NeoChord implantation: Single-center early results. J Card Surg 2021; 36:4205-4210. [PMID: 34462962 PMCID: PMC9291066 DOI: 10.1111/jocs.15953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Micro-invasive cardiac surgery identifies procedures performed off-pump, on beating heart. Aim of this single-center retrospective study was to assess early outcomes of a totally micro-invasive strategy (percutaneous coronary intervention-PCI-followed by transapical off-pump NeoChord mitral repair) in patients with concomitant coronary artery disease (CAD) and degenerative mitral regurgitation (MR). METHODS We analyzed early and 1-year follow-up data of patients who underwent a NeoChord procedure between November 2013 and May 2020, and preceded by PCI. Outcomes were defined according to Mitral Valve Academic Research Consortium (MVARC) definitions. RESULTS Among 220 patients who underwent NeoChord repair in the study period, 17 (7.7%) underwent PCI previously. CAD was an accidental finding during preoperative mitral evaluation in nine patients (52.9%; Group 1; with PCI occurring 2 months before NeoChord, interquartile range [IQR] = 1.0-2.7), while it was part of the past medical history in the remaining eight patients (47.1%; Group 2; with PCI occurring 30 months before NeoChord, IQR = 24.5-64.0). Twelve patients (70.6%) presented single-vessel disease, two patients (11.8%) triple-vessel disease. No surgical revisions for bleeding were required after NeoChord. At 1-year follow-up (n = 16), all patients were alive and did not experience major adverse events except for one reoperation due to late NeoChord failure. None required additional PCI. CONCLUSION In our experience, PCI before NeoChord seems safe and effective, and performing PCI before NeoChord might not affect outcomes. A totally micro-invasive strategy in selected patients suffering from MR and CAD should be considered as a reasonable alternative to conventional surgery.
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Affiliation(s)
- Nicola Pradegan
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Augusto D'Onofrio
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Lorenzo Longinotti
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Evangelista
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Florinda Mastro
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Fiocco
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Matteo Nadali
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gino Gerosa
- Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
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Komarov RN, Kleshchev PV. [Current problems of simultaneous surgery of the aortic valve and ischaemic heart disease]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:168-174. [PMID: 33332320 DOI: 10.33529/angio2020416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Surgical policy in treatment of patients suffering from concomitant valvular pathology and ischaemic heart disease is an extremely important problem of contemporary cardiac surgery. With the advent of advanced techniques and due to the improvement of old ones, there have over the last decades appeared new approaches to treatment of this cohort of patients. Presented in the article is a review of current publications regarding the problem of surgical treatment of patients with a combination of pronounced valvular pathology requiring surgical correction and ischaemic heart disease necessitating the need for myocardial revascularization. This is followed by providing the data concerning contemporary strategies of treatment of patients with concomitant pathology, as well as the comparison of various approaches and the effect of the chosen technique on the outcome.
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Affiliation(s)
- R N Komarov
- Department of Cardiovascular and Aortic Surgery, University Clinical Hospital #1, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - P V Kleshchev
- Cardiosurgical Department #42, Chief Military Clinical Hospital named after Academician N.N. Burdenko, Moscow, Russia
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9
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Rosol Z, Vasudevan A, Sawhney R, Hebeler RF, Tecson KM, Stoler RC. Hybrid intervention approach to coronary artery and valvular heart disease. Proc (Bayl Univ Med Cent) 2020; 33:520-523. [PMID: 33100519 DOI: 10.1080/08998280.2020.1784638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Coronary angiography is used to assess the burden of coronary artery disease prior to surgical valve repair/replacement and often leads to concomitant bypass and valve surgery. We sought to evaluate outcomes of an alternative, hybrid approach involving percutaneous coronary intervention (PCI) and valve surgery, assessing the rate of stent thrombosis as a primary outcome. We reviewed charts of consecutive patients who underwent planned PCI prior to surgical valve repair/replacement by a single surgeon from January 2008 to December 2016. We calculated rates of surgical complication, duration of dual antiplatelet therapy (DAPT) prior to surgery, and rates of stent thrombosis and in-stent restenosis. Twenty-four patients were included in this study. Surgery was performed a median of 52.5 days following PCI. DAPT was withheld an average of 8 days before and resumed an average of 4 days after surgery. Ninety-two percent of surgeries were minimally invasive. There were no bleeding complications, stent thromboses, or restenosis events. All patients survived the 1-year follow-up. For patients with mixed coronary and valvular heart disease, a heart team approach involving preoperative PCI followed by staged minimally invasive valvular surgery appears to be safe and warrants further exploration.
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Affiliation(s)
- Zachary Rosol
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Anupama Vasudevan
- Baylor Heart and Vascular Institute, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
| | - Rahul Sawhney
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Robert F Hebeler
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
| | - Robert C Stoler
- Baylor University Medical Center, Dallas, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas.,College of Medicine, Texas A&M Health Science Center, Dallas, Texas
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10
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A comparison of surgical, total percutaneous, and hybrid approaches to treatment of combined coronary artery and valvular heart disease. Curr Opin Cardiol 2020; 35:559-565. [DOI: 10.1097/hco.0000000000000764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Grinberg D, Pozzi M, Bordet M, Nouhou KA, Kwon YJ, Obadia JF, Vola M. Minithoracotomy and Beating Heart Strategy for Mitral Surgery in Secondary Mitral Regurgitation. Thorac Cardiovasc Surg 2019; 68:462-469. [PMID: 31242521 DOI: 10.1055/s-0039-1692403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND In patients with secondary mitral regurgitation (MR) associated with low ejection fraction or previous heart surgery, minimally invasive mitral valve surgery without aortic cross-clamp (MIMVS-WAC) has shown promising results. We report our experience for this strategy in our centers. METHODS Between August 2011 and April 2017, 46 patients (mean age 69 ± 11 years, 76% males) received MIMVS-WAC. Indications for this technique were prior coronary bypass surgery (26%), severe or recent left ventricular (LV) dysfunction (30%), or both (39%). The mean EuroSCORE II was 12 ± 10. RESULTS For each procedure, we conducted right minithoracotomy and hypothermic cardiopulmonary bypass (CPB) after peripheral cannulation. Mean CPB time was 159 ± 39 minutes. A mitral valve replacement (MVR) was performed in 23 cases (50%), an annuloplasty in 22 cases (48%), and a prosthesis pannus removal in 1 case (2%). Mean hospital length of stay was 12 ± 5.4 days. We report no sternotomy conversions, six reoperations for bleeding, and three deaths at 30 days. Transfusion was requested in 62% (mean infusion 2 ± 2.4 packed red blood cells). The postoperative echocardiography showed an LV function preservation in 69% of cases and a reduction of pulmonary arterial pressure in 73% of cases. Four additional deaths occurred in the long-term follow-up (mean 637 ± 381 days, median 593 days). No mitral reoperation was required, with a MR ≤ 2 in 90% of patients. CONCLUSION In high-risk patients, the MIMVS-WAC is a safe technique. It avoids hard dissections while ensuring excellent preservation of cardiac function.
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Affiliation(s)
- Daniel Grinberg
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France.,Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York.,Sinai Biodesign and department of neurosurgery at Icahn School of Medicine and Mount Sinai Health system, New York, New York
| | - Matteo Pozzi
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
| | - Marine Bordet
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
| | - Kaled Adamou Nouhou
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
| | - Young Joon Kwon
- Sinai Biodesign and department of neurosurgery at Icahn School of Medicine and Mount Sinai Health system, New York, New York
| | - Jean-François Obadia
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France
| | - Marco Vola
- Department of Adult Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Lyon Medical School, Lyon, France.,Department of Cardiovascular Surgery, Saint-Etienne Medical School, Saint-Etienne, France
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Aortic Valve Replacement and Concomitant Right Coronary Artery Bypass Grafting Performed via a Right Minithoracotomy Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 9:302-5. [DOI: 10.1097/imi.0000000000000081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective We present our experience of concomitant right coronary artery bypass grafting (CABG) and aortic valve replacement performed via a right minithoracotomy in patients with coronary lesions not amenable to percutaneous intervention. Methods A total of 17 patients underwent concomitant aortic valve replacement and right CABG between April 2008 and July 2013.A5-to 6-cm minithoracotomy incision was made over the right second or third intercostal space, and the costochondral cartilage was transected. A saphenous vein bypass to the right coronary artery was then performed, initiating the anastomosis from the toe of the graft. Subsequently, the aortic valve was replaced using standard techniques. Results There were 6 men and 11 women. The median European System for Cardiac Operative Risk Evaluation II score mortality risk was 5% [interquartile range (IQR), 2%-8%]. The mean (SD) age was 77 (10) years, the left ventricular ejection fraction was 59% (8%), and the New York Heart Association functional class was 2.4 (0.8). One patient had a history of CABG. The mean (SD) cardiopulmonary bypass time was 168 (57) minutes, and the aortic cross-clamp time was 133 (36) minutes. Three patients underwent concomitant mitral valve surgery (replacement, 2; repair, 1). The median intensive care unit and hospital lengths of stay were 47 hours (IQR, 24–90) and 9 days (IQR, 5–13), respectively. There was one reoperation for bleeding, and there was one postoperative stroke. All patients were alive at a mean (SD) follow-up of 2 (1.1) years. Conclusions Aortic valve replacement with concomitant CABG performed via a right minithoracotomy approach is feasible.
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Alqahtani F, Ziada K, Rihal CS, Alkhouli M. Incidence and outcomes of early percutaneous coronary intervention after isolated valve surgery. Catheter Cardiovasc Interv 2018; 93:583-589. [PMID: 30269409 DOI: 10.1002/ccd.27874] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/20/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Coronary ischemia requiring early percutaneous coronary intervention (PCI) is a rare but serious complication of isolated valve surgery. We sought of assess the incidence, predictors and outcomes of early PCI after isolated valve surgery using the national inpatient sample. METHODS Patients who underwent isolated aortic valve replacement (AVR), isolated mitral valve repair (MVr) or replacement (MVR) between 2003 and 2014 were identified. Patients who had early postoperative PCI were compared with patients who did not require PCI. Primary end point was in-hospital mortality. Secondary endpoints were complications, length-of-stay and cost. RESULTS Among the 135,611 included patients, 1,074 (0.8%) underwent PCI prior to discharge. Unadjusted in-hospital mortality was higher in patients requiring early PCI following AVR (11.2 vs. 3.1%), MVR (24.1 vs. 5.5%), and MVr (22.4 vs. 2.5%) (P < 0.001) compared with patients not requiring PCI. Postoperative PCI remained independently associated with higher mortality after adjusting for demographics, comorbidities and hospital characteristics (adjusted OR [aOR] = 3.74, 95%CI 2.70-5.17 for AVR, aOR = 6.10, 95%CI 4.53-8.23 for MVR, and aOR = 9.90, 95%CI 7.22-13.58 for MVr). Patients undergoing PCI had higher incidences of stroke, acute kidney injury, infectious complications, higher hospital charges, and longer hospitalizations. Age, robotic-assisted surgery, and chronic renal failure were independent predictors of needing early postoperative PCI. CONCLUSIONS Early PCI after isolated aortic or mitral valve surgery is rare but is associated with substantial in-hospital morbidity, mortality, and cost. Further studies are needed to identify preventable causes, and optimal management strategies of this serious complication.
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Affiliation(s)
- Fahad Alqahtani
- Department of Medicine, Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
| | - Khaled Ziada
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - Charanjit S Rihal
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Mohamad Alkhouli
- Department of Medicine, Division of Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, West Virginia
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Santana O, Xydas S, Williams RF, LaPietra A, Mawad M, Wigley JC, Beohar N, Mihos CG. Percutaneous coronary intervention followed by minimally invasive valve surgery compared with median sternotomy coronary artery bypass graft and valve surgery in patients with prior cardiac surgery. J Thorac Dis 2017; 9:S575-S581. [PMID: 28740710 DOI: 10.21037/jtd.2017.04.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND In patients with prior cardiac surgery requiring re-operative coronary and valve surgery, a hybrid approach of percutaneous coronary intervention followed by minimally invasive valve surgery (PCI + MIVS) may be an alternative to the standard median sternotomy coronary artery bypass and valve surgery (CABG + valve). METHODS The outcomes of patients with prior cardiac surgery, presenting with coronary artery and valvular disease, who underwent PCI + MIVS (N=39) were retrospectively compared with those who underwent CABG + valve (N=28) via a repeat median sternotomy, between February 2009 and April 2014. RESULTS The mean age for the PCI + MIVS versus CABG + valve group was 75±9 and 72±11 years (P=0.54), respectively. The baseline characteristics were similar between groups, with the exception of a greater prevalence of 1-vessel coronary artery disease and clopidogrel or dual antiplatelet therapy at the time of surgery in the PCI + MIVS group, and more 3-vessel coronary artery disease in those undergoing CABG + valve surgery. The PCI + MIVS approach was associated with a decreased aortic cross-clamp (94 vs. 131 minutes, P=0.001) and cardiopulmonary bypass (128 vs. 190 minutes, P<0.001) times, fewer intraoperative packed red blood transfusions (1.3 vs. 3.8 units, P=0.001), shorter intensive care unit length of stay (41 vs. 71 hours, P<0.001), and decreased incidence of prolonged mechanical ventilation (12.8% vs. 35.7%, P=0.03), re-intubation (2.6% vs. 17.9%, P=0.04), when compared with CABG + valve. The thirty-day and two-year mortality were similar, being 7.7% vs. 7.1% (P=0.66), and 12.8% vs. 10.7% (P=0.55), in the PCI + MIVS vs. CABG + valve group, respectively. CONCLUSIONS Hybrid PCI + MIVS in patients with prior cardiac surgery is associated with shorter operative times and intensive care unit length of stay, less need for intraoperative blood cell transfusions, decreased use of mechanical ventilation, and similar short-term and follow-up survival, when compared with CABG + valve surgery via median sternotomy. Randomized trials and multicenter registries are needed to further evaluate this approach.
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Affiliation(s)
- Orlando Santana
- The Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Steve Xydas
- The Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Roy F Williams
- The Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Angelo LaPietra
- The Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Maurice Mawad
- The Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Jason C Wigley
- The Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Nirat Beohar
- The Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Santana O, Xydas S, Williams RF, Mawad M, Heimowitz TB, Pineda AM, Goldman HS, Mihos CG. Hybrid approach of percutaneous coronary intervention followed by minimally invasive mitral valve surgery: a 5-year single-center experience. J Thorac Dis 2017; 9:S595-S601. [PMID: 28740712 DOI: 10.21037/jtd.2017.06.29] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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. METHODS A total of 93 patients who underwent PCI + MIMVS for coronary artery and MV disease between February 2009 and April 2014 were retrospectively analyzed. 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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Affiliation(s)
- Orlando Santana
- Division of Cardiology, The Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Steve Xydas
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Roy F Williams
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Maurice Mawad
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Todd B Heimowitz
- Division of Cardiology, The Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Andrés M Pineda
- Cardiac Catheterization Laboratory, Duke University Medical Center, Durham, UK
| | - Howard S Goldman
- Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Santana O, Xydas S, Williams RF, LaPietra A, Mawad M, Rosen GP, Beohar N, Mihos CG. Outcomes of a hybrid approach of percutaneous coronary intervention followed by minimally invasive aortic valve replacement. J Thorac Dis 2017; 9:S569-S574. [PMID: 28740709 DOI: 10.21037/jtd.2017.04.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
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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Affiliation(s)
- Orlando Santana
- The Columbia University Division of Cardiology, at the Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Steve Xydas
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Roy F Williams
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Angelo LaPietra
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Maurice Mawad
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Gerald P Rosen
- The Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Nirat Beohar
- The Columbia University Division of Cardiology, at the Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Mihos CG, Xydas S, Williams RF, Pineda AM, Yucel E, Davila H, Beohar N, Santana O. 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. J Thorac Dis 2017; 9:S563-S568. [PMID: 28740708 DOI: 10.21037/jtd.2017.04.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The optimal treatment for concomitant two-vessel coronary artery disease (CAD) and moderate to severe ischemic mitral regurgitation (IMR) remains unclear. We compared the results of a staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery (PCI+MIVS) versus combined coronary artery bypass graft and mitral valve surgery (CABG+MVS) in this population. METHODS All consecutive patients with two-vessel CAD and moderate to severe IMR, who underwent PCI+MIVS or CABG+MVS at our institution between February 2009 and April 2014, were retrospectively evaluated. RESULTS There were nine patients identified who underwent PCI+MIVS, and 15 who underwent CABG+MVS, with a mean age of 71±7, and 70±7 years, respectively (P=0.86). The remaining baseline characteristics were similar between both groups, with the exception of a higher prevalence of pre-operative clopidogrel administration (78% versus 27%, P=0.03) and left anterior descending plus left circumflex CAD (78% versus 27%, P=0.03), in those who underwent PCI+MIVS. The PCI+MIVS approach was associated with decreased mean cardiopulmonary bypass (111±41 versus 167±49 min, P=0.01) and aortic cross-clamp (79±32 versus 129±35 min, P=0.003) times, and less median number of intraoperative packed red blood transfusions {2 [interquartile range (IQR), 0-2] versus 3 units (IQR, 1-4), P=0.05}, when compared with CABG+MVS. The rate of mitral valve repair, postoperative complications, 30-day mortality, and 1-year survival did not differ between the surgical approaches. CONCLUSIONS PCI+MIVS for two-vessel CAD and moderate to severe IMR is feasible, and associated with satisfactory outcomes, as compared with CABG+MVS.
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Affiliation(s)
- Christos G Mihos
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steve Xydas
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Roy F Williams
- The Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Andrés M Pineda
- Cardiac Catheterization Laboratory, Duke University Medical Center, Durham, NC, USA
| | - Evin Yucel
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hector Davila
- Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Nirat Beohar
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL, USA
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Affiliation(s)
- Joseph Lamelas
- Division of Cardiovascular Surgery, Michael E. DeBakey Department of Surgery, Houston, TX, USA
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Outcomes of a Combined Approach of Percutaneous Coronary Revascularization and Cardiac Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:4-8. [PMID: 28092294 DOI: 10.1097/imi.0000000000000342] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A subset of patients requiring coronary revascularization and valve surgery may benefit from a combined approach of percutaneous coronary intervention (PCI) and valve surgery, as opposed to the standard median sternotomy approach of combined coronary artery bypass and valve surgery. To evaluate its potential benefits and limitations, a literature search was performed using PubMed, EMBASE, Ovid, and the Cochrane library, through March 2016 to identify all studies involving a combined approach of PCI and valve surgery in patients with coronary artery and valvular disease. There were five studies included in the study with a total of 324 patients, of which 75 (23.1%) had a history of previous cardiac surgery. The interval between PCI and surgery ranged from simultaneous intervention to a median of 38 days (interquartile range, 18-65 days). The surgical approach performed consisted of a minimally invasive one or median sternotomy. There were 275 single valve surgery (84.9%) and 49 double-valve surgery (15.1%) with a 30-day mortality ranging from 0% to 5.5%. The 1-year survival ranged from 78% to 96%, and the follow-up period ranged from 1.3 to 5 years. Herein, we present a review of the literature using this technique.
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Pineda AM, Gowani SA, Mihos CG, Chandra R, Santana O, Lamelas J, Beohar N. Coronary Artery Disease Complexity on the Outcomes of a Staged Approach of Pci Followed by Minimally Invasive Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Andrés M. Pineda
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Saqib A. Gowani
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Christos G. Mihos
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Ramesh Chandra
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Joseph Lamelas
- Department of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Nirat Beohar
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL USA
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Shikuma A, Shiraishi J, Okawa K, Yashige M, Shoji K, Ito D, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Takahashi A, Sawada T. Primary Percutaneous Coronary Intervention Followed by Valve Surgery for Acute Coronary Syndrome at Left Main Trunk Complicated With Severe Aortic Stenosis. Int Heart J 2017; 58:125-130. [PMID: 28100876 DOI: 10.1536/ihj.16-186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
An 89-year-old woman appeared to have acute coronary syndrome at the left main trunk (LMT) complicated with severe aortic stenosis, moderate-severe mitral regurgitation, depressed left ventricular (LV) function, and multivessel disease. Because of sustained hypotension even under intra-aortic balloon pumping support during emergency coronary angiograhy, we performed primary percutaneous coronary intervention solely for the LMT lesion using a bare metal stent, leading to recovery from the shock state. On the second hospital day, based on our heart-team consensus, we performed aortic valve replacement and coronary artery bypass grafting surgery, and added edge-to-edge repair (Alfieri stitch) of the mitral valve, resulting in complete revascularization and dramatically improved LV function.
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Affiliation(s)
- Akira Shikuma
- Department of Cardiology, Kyoto First Red Cross Hospital
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Coronary Artery Disease Complexity on the Outcomes of a Staged Approach of PCI Followed by Minimally Invasive Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:95-101. [PMID: 28129316 DOI: 10.1097/imi.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the combined coronary artery bypass graft and valve surgery for patients with concomitant coronary artery (CAD) and valvular heart disease. We sought to evaluate the impact of the complexity of CAD, as assessed by the Syntax score, on the outcomes of the staged approach. METHODS We retrospectively evaluated 138 patients who underwent PCI and MIVS at our institution between January 2009 and June 2013. The baseline Syntax score was calculated, and the patients were divided into two groups: low risk (Syntax scores, 0-22) or intermediate-high risk (>22). RESULTS There were 125 patients with low (mean ± standard deviation, 8 ± 5) and 13 with intermediate-high (mean ± standard deviation, 26 ± 4) Syntax scores. Baseline, PCI, and operative characteristics were similar between the groups, except for an observed higher incidence of peripheral arterial disease, multivessel coronary disease, mitral valve replacement, and a higher predicted The Society of Thoracic Surgeons mortality risk score in the intermediate-high Syntax group. The short-term postoperative complications, 30-day mortality, and 3-year survival (84% vs 77%) were similar between the groups. Patients in the intermediate-high-risk group had a higher incidence of repeat target vessel revascularization during follow-up (0.8% vs 16.7%). CONCLUSIONS A staged approach of PCI followed by MIVS is a safe and feasible alternative for patients with valvular heart disease and concomitant CAD. However, it may confer an increased incidence of repeat target vessel revascularization in patients with intermediate- to high-complexity CAD.
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Papakonstantinou NA, Baikoussis NG, Dedeilias P, Argiriou M, Charitos C. Cardiac surgery or interventional cardiology? Why not both? Let's go hybrid. J Cardiol 2017; 69:46-56. [DOI: 10.1016/j.jjcc.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 07/30/2016] [Accepted: 09/08/2016] [Indexed: 01/27/2023]
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Wang TKM, Choi DHM, Ramanathan T, Ruygrok PN. Aortic Valve Replacement With or Without Concurrent Coronary Artery Bypass Grafting in Octogenarians: Eight-Year Cohort Study. Heart Lung Circ 2017; 26:82-87. [DOI: 10.1016/j.hlc.2016.04.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 04/26/2016] [Accepted: 04/29/2016] [Indexed: 11/26/2022]
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Santana O, Singla S, Mihos CG, Pineda AM, Stone GW, Kurlansky PA, George I, Kirtane AJ, Smith CR, Beohar N. Outcomes of a Combined Approach of Percutaneous Coronary Revascularization and Cardiac Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Orlando Santana
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Sandeep Singla
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Christos G. Mihos
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Andres M. Pineda
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
| | | | | | - Isaac George
- Columbia University Medical Center, New York, NY USA
| | | | | | - Nirat Beohar
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA
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Percutaneous Coronary Intervention Followed by Minimally Invasive Mitral Valve Surgery in Ischemic Mitral Regurgitation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015; 10:394-7. [PMID: 26655933 DOI: 10.1097/imi.0000000000000218] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The optimal treatment strategy in patients with coronary artery disease and ischemic mitral regurgitation (IMR) remains controversial. A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery, rather than combined median sternotomy coronary artery bypass and valve surgery, may be a viable alternative. METHODS We retrospectively evaluated 31 consecutive patients with coronary artery disease and severe IMR who underwent a staged procedure at our institution between February 2009 and April 2014. RESULTS The mean ± SD age, preoperative left ventricular ejection fraction, and mitral regurgitation grade were 72 ± 7 years, 35% ± 11%, and 3.6 ± 0.6, respectively. The mean ± SD Society of Thoracic Surgeons-predicted mortality score was 5.1% ± 4.2%. Percutaneous coronary intervention was performed for 1- and 2-vessel disease in 22 patients (71%) and 9 patients (29%), respectively, with 23 patients (74%) having drug-eluting stents placed. Minimally invasive valve surgery was performed within a median of 36 days after PCI, with 61% of the patients being on dual antiplatelet therapy. Postoperatively, there was 1 case of acute kidney injury, 1 case of reoperation for bleeding, and no cerebrovascular accidents. The 30-day mortality was 3%. The median total hospital length of stay was 8 days (interquartile range, 7-10). At a mean ± SD follow-up of 2.4 ± 1.6 years, 2 patients required PCI for target-vessel revascularization. Actuarial survival at 1 and 5 years was 84% and 80%, respectively. CONCLUSIONS A staged approach in patients with coronary artery disease and IMR can be performed with a low perioperative morbidity and good midterm survival.
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Abstract
Ischemic mitral regurgitation (IMR) is a complicated medical condition with varying degrees of coronary artery disease and mitral regurgitation (MR). The traditional surgical treatment option for those with indications for intervention is coronary artery bypass grafting (CABG) plus or minus mitral valve repair or replacement (MVR). Percutaneous coronary intervention, hybrid coronary revascularization (HCR), and conventional CABG are three techniques available to address coronary artery disease (CAD). Percutaneous edge-to-edge repair, minimally invasive, and traditional sternotomy are accepted approaches for the treatment of MR. When taken in combination, there are nine methods available to revascularize the myocardium and restore competency to the mitral valve. While most of these treatment options have not been studied in detail, they may offer novel solutions to a widely variable and complex IMR patient population. Thus, a comparative analysis including an examination of potential benefits and risks will be helpful and potentially allow for more patient-specific treatment strategies.
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Affiliation(s)
- David H Scoville
- Stanford University, Department of Cardiothoracic Surgery, Stanford, California, USA
| | - Jack B H Boyd
- Stanford University, Department of Cardiothoracic Surgery, Stanford, California, USA
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Pineda AM, Chandra R, Gowani SA, Santana O, Mihos CG, Kirtane AJ, Stone GW, Kurlansky P, Smith CR, Beohar N. Completeness of revascularization and its impact on the outcomes of a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery for patients with concomitant coronary artery and valvular heart disease. Catheter Cardiovasc Interv 2015; 88:329-37. [PMID: 26526421 DOI: 10.1002/ccd.26294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 10/02/2015] [Indexed: 11/08/2022]
Abstract
BACKGROUND A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease. Limited data exist on degree of the completeness of revascularization achieved with this approach and its impact on outcomes. METHODS A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated. Coronary angiograms were reviewed by two cardiologists blinded to outcomes and were then categorized into two groups: complete or incomplete revascularization, which was defined as ≥1 major epicardial coronary arteries of at least 2.0 mm diameter with ≥70% untreated obstruction after the index PCI and before MIVS. RESULTS Complete and incomplete revascularization was achieved in 105 (76%) and 33 (24%) patients, respectively. The patients with incomplete revascularization had a lower ejection fraction, a higher STS score, and more prior myocardial infarctions and multi-vessel coronary artery disease. There were no differences in the post-operative complications, 30-day mortality, or 3-year survival (84 vs. 83%, P = 0.68). After a median follow-up of 29 months, incompletely revascularized patients had a higher incidence of acute coronary syndrome (2.9 vs. 12.9%, P = 0.05). CONCLUSIONS In patients undergoing a staged approach of PCI followed by MIVS, incomplete revascularization did not significantly impact the short or mid-term survival, but was associated with an increased incidence of acute coronary syndrome at follow-up. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrés M Pineda
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida
| | - Ramesh Chandra
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida
| | - Saqib A Gowani
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida
| | - Orlando Santana
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida
| | - Christos G Mihos
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida
| | | | - Gregg W Stone
- Columbia University Medical Center, New York, New York
| | | | - Craig R Smith
- Columbia University Medical Center, New York, New York
| | - Nirat Beohar
- Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida.
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Mihos CG, Santana O, Pineda AM, Stone GW, Hasty F, Beohar N. Percutaneous Coronary Intervention Followed by Minimally Invasive Mitral Valve Surgery in Ischemic Mitral Regurgitation. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2015. [DOI: 10.1177/155698451501000605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Christos G. Mihos
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Orlando Santana
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Andrés M. Pineda
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
| | | | - Frederick Hasty
- Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Nirat Beohar
- Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA
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George I, Nazif TM, Kalesan B, Kriegel J, Yerebakan H, Kirtane A, Kodali SK, Williams MR. Feasibility and Early Safety of Single-Stage Hybrid Coronary Intervention and Valvular Cardiac Surgery. Ann Thorac Surg 2015; 99:2032-7. [PMID: 25865767 DOI: 10.1016/j.athoracsur.2015.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 12/27/2014] [Accepted: 01/06/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hybrid percutaneous coronary intervention offers an alternative method of revascularization for high-risk surgical populations. We report the outcomes of a single-stage hybrid strategy in valvular cardiac surgery and explore its effects on operative risk and bleeding. METHODS In a hybrid operating room, 26 patients underwent hybrid surgery consisting of femoral arterial access, then coronary stenting followed by valve surgery, with appropriate heparin dosing. Clopidogrel (300 mg) was given on anesthesia induction in nonreoperative cases, or at the time of cross clamping (after stenting) for reoperative cases. RESULTS Mean follow-up was 680 ± 277 days. The planned coronary stenting and surgery was successful in all patients. Major cardiovascular and cerebrovascular adverse events occurred in 1 patient, with no inhospital deaths observed. No vascular complication or stent thrombosis was observed with the described antiplatelet regimen. Outcomes were comparable to those of standard bypass valve replacement surgery. CONCLUSIONS This study demonstrates the feasibility and early safety of a single-stage hybrid strategy with coronary stenting followed by valvular surgery in patients at increased surgical risk. Hybrid procedures may lower operative risk by eliminating or reducing the need for bypass grafting.
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Affiliation(s)
- Isaac George
- Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York; Interventional Cardiology, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York.
| | - Tamim M Nazif
- Interventional Cardiology, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Bindu Kalesan
- Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jacob Kriegel
- Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Halit Yerebakan
- Division of Cardiothoracic Surgery, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ajay Kirtane
- Interventional Cardiology, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Susheel K Kodali
- Interventional Cardiology, New York-Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mathew R Williams
- Division of Adult Cardiac Surgery, New York University Langone Medical Center, New York, New York
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Lamelas J. Concomitant minithoracotomy aortic and mitral valve surgery: the minimally invasive "Miami Method". Ann Cardiothorac Surg 2015; 4:85-7. [PMID: 25694984 DOI: 10.3978/j.issn.2225-319x.2014.09.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/17/2014] [Indexed: 11/14/2022]
Affiliation(s)
- Joseph Lamelas
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, Florida 33140, USA
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Poulin A, Rodés-Cabau J, Paradis JM. Management of Coronary Disease in the Era of Transcatheter Aortic Valve Replacement: Comprehensive Review of the Literature. Interv Cardiol Clin 2015; 4:13-21. [PMID: 28582119 DOI: 10.1016/j.iccl.2014.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Among the cohort of complex and multifaceted patients undergoing transcatheter aortic valve replacement (TAVR), the prevalence of coronary artery disease (CAD) ranges from 48% to 75%. However, optimal management of CAD in this setting has not been established. This article provides a comprehensive review of the literature to depict the actual knowledge on the subject of aortic stenosis and concomitant CAD. This article also aids heart teams in their decision-making process to appropriately manage these challenging patients with aortic stenosis and CAD. Upcoming randomized studies will clarify the influence of CAD, the best timing for percutaneous coronary intervention, and its impact on TAVR results.
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Affiliation(s)
- Anthony Poulin
- Department of Cardiology, Interventional Cardiology Division, Quebec Heart and Lung Institute, 2725, Chemin Sainte-Foy, Québec, Quebec G1V 4G5, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Interventional Cardiology Division, Quebec Heart and Lung Institute, 2725, Chemin Sainte-Foy, Québec, Quebec G1V 4G5, Canada
| | - Jean-Michel Paradis
- Department of Cardiology, Interventional Cardiology Division, Quebec Heart and Lung Institute, 2725, Chemin Sainte-Foy, Québec, Quebec G1V 4G5, Canada; Cardiovascular Research Foundation, 111 East 59th Street, New York, NY 10022, USA.
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Boix-Garibo R, Uzzaman MM, Bapat VN. Review of Minimally Invasive Aortic Valve Surgery. Interv Cardiol 2015; 10:144-148. [PMID: 29588692 DOI: 10.15420/icr.2015.10.03.144] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Minimally invasive aortic valve surgery (MIAVS) has been developed for the last 20 years. The improvements in techniques have permitted cardiac surgeons to perform aortic valve replacement safely and efficiently with minimally incisions. Patients have become older and have multiple comorbidities and this is expected to grow in number. Less-invasive procedures are known to reduce the number of complications, together with smaller incisions, less pain, less blood loss and reduced length of hospital stay. Selective preoperative planning with computed tomography is key to the pre-investigation stage. Hybrid and staged procedures with interventional cardiologists are part of the armamentarium and may be appealing for the present and near future. Despite the nature of demanding procedures and longer learning curve with increased cardiopulmonary bypass times, the outcomes are comparable with same quality as conventional open surgery. Patient recovery is the ultimate purpose of these approaches.
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Affiliation(s)
- Ricardo Boix-Garibo
- Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
| | | | - Vinayak Nilkanth Bapat
- Department of Cardiothoracic Surgery, St Thomas' Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK
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Lamelas J, Nguyen TC. Minimally Invasive Valve Surgery: When Less Is More. Semin Thorac Cardiovasc Surg 2015; 27:49-56. [DOI: 10.1053/j.semtcvs.2015.02.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2015] [Indexed: 11/11/2022]
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Paradis JM, Fried J, Nazif T, Kirtane A, Harjai K, Khalique O, Grubb K, George I, Hahn R, Williams M, Leon MB, Kodali S. Aortic stenosis and coronary artery disease: What do we know? What don't we know? A comprehensive review of the literature with proposed treatment algorithms. Eur Heart J 2014; 35:2069-2082. [DOI: 10.1093/eurheartj/ehu247] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Mihos CG, Santana O, Pineda AM, La Pietra A, Lamelas J. Aortic Valve Replacement and Concomitant Right Coronary Artery Bypass Grafting Performed via a Right Minithoracotomy Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014. [DOI: 10.1177/155698451400900408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Orlando Santana
- Divisions of Cardiology, Columbia University, Miami Beach, FL USA
| | - Andres M. Pineda
- Divisions of Cardiology, Columbia University, Miami Beach, FL USA
| | - Angelo La Pietra
- Divisions of Cardiac Surgery, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL USA
| | - Joseph Lamelas
- Divisions of Cardiac Surgery, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL USA
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Santana O, Pineda AM, Cortes-Bergoderi M, Mihos CG, Beohar N, Lamas GA, Lamelas J. Hybrid approach of percutaneous coronary intervention followed by minimally invasive valve operations. Ann Thorac Surg 2014; 97:2049-55. [PMID: 24725838 DOI: 10.1016/j.athoracsur.2014.02.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 02/14/2014] [Accepted: 02/20/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND A subset of patients requiring coronary revascularization and valve operations may benefit from a hybrid approach of percutaneous coronary intervention (PCI) followed by a minimally invasive valve operation, rather than the standard combined median sternotomy coronary artery bypass grafting (CABG) and a valve operation. This study sought to evaluate the outcomes of this approach in a heterogeneous group of patients with concomitant coronary artery and valvular disease. METHODS We retrospectively evaluated 222 consecutive patients with coronary artery and valvular heart disease who underwent PCI followed by elective minimally invasive valve operations at our institution between February 2009 and August 2013. RESULTS A total of 136 men and 86 women were identified. The mean age was 74.6 ± 8.2 years, with 181 (81.5%) undergoing 1-vessel, 27 (12.2%) undergoing 2-vessel, and 14 (6.3%) undergoing 3-vessel PCI. Within a median of 38 days (interquartile range [IQR] 18-65 days), 182 (82%) patients underwent primary and 34 (15.3%) underwent repeated valve operations, which consisted of 185 (83.3%) single-valve and 37 (16.7%) double-valve procedures. Operative mortality occurred in 8 patients (3.6%). At a mean follow-up of 16.2 ± 12 months, 6 patients required PCI, with target-vessel revascularization performed in 4 patients (2.1%). Survival at 1 and 4.5 years was 91.9% and 88.3%, respectively. CONCLUSIONS In a heterogeneous group of patients, a hybrid approach of PCI followed by minimally invasive valve operations in patients undergoing primary or repeated valve operations can be performed with excellent outcomes.
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Affiliation(s)
- Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida.
| | - Andrés M Pineda
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida
| | | | - Christos G Mihos
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida
| | - Nirat Beohar
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida
| | - Gervasio A Lamas
- Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida
| | - Joseph Lamelas
- Division of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida
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Lamelas J, Mihos C, Santana O. Surgical technique: papillary muscle sling for functional mitral regurgitation during minimally invasive valve surgery. Heart Surg Forum 2013; 16:E295-7. [PMID: 24364086 DOI: 10.1532/hsf98.2013209] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach.
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Minimally invasive valve surgery with bypass to the right coronary artery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:440-2. [PMID: 24356434 DOI: 10.1097/imi.0000000000000033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Herein, we report the case of a 60-year-old woman who presented with increasing dyspnea on exertion. Echocardiography revealed significant aortic and mitral regurgitation, which were most likely secondary to previous radiation therapy for breast cancer. On cardiac catheterization a 90% ostial right coronary artery lesion was found and treated with a drug-eluting stent. During minimally invasive valve surgery, via a right anterior thoracotomy, it was noted that the stent had restenosed. Therefore, the right coronary artery was bypassed with a segment of venous graft through the same incision.
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Joshi D, Santana O, LaPietra A, Lamelas J. Minimally Invasive Valve Surgery with Bypass to the Right Coronary Artery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Devendra Joshi
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Orlando Santana
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Angelo LaPietra
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL USA
| | - Joseph Lamelas
- Division of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, FL USA
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Santana O, Lamelas J. Response to staged percutaneous coronary intervention and minimally invasive valve surgery: results of a hybrid approach to concomitant coronary and valvular disease. J Thorac Cardiovasc Surg 2013; 146:993-4. [PMID: 24041167 DOI: 10.1016/j.jtcvs.2013.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 05/23/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Orlando Santana
- Division of Cardiology, Columbia University, Miami Beach, Fla
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Grubb KJ, Nazif T, Williams MR, George I. Concurrent Coronary Artery and Valvular Heart Disease - Hybrid Treatment Strategies in 2013. Interv Cardiol 2013; 8:127-130. [PMID: 29588765 DOI: 10.15420/icr.2013.8.2.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Concomitant coronary artery disease (CAD) and valvular heart disease is an increasingly common problem in the ageing population. Hybrid procedures combine surgical and transcatheter approaches to facilitate minimally invasive surgery or to transform a single high-risk open surgery into two less risky procedures. In ideal circumstances, this strategy may decrease the surgical risk in elderly, high-risk and reoperative surgical candidates, while improving patient comfort, convenience and cost-effectiveness. Hybrid procedures can be performed in a staged fashion or as a 'one-stop' procedure in a hybrid operating suite. Increasing evidence supports the safety and short-term efficacy of hybrid valve repair or replacement and coronary revascularisation procedures. Nevertheless, important questions remain, including the optimal timing of the individual procedures and the optimal antiplatelet therapy after percutaneous coronary intervention. With ongoing advances in procedural techniques and anticoagulation strategies, as well as the accumulation of long-term outcomes data, hybrid approaches to concomitant CAD and valvular heart disease will likely become increasingly common.
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Affiliation(s)
- Kendra J Grubb
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons
| | - Tamim Nazif
- Division of Cardiology, Columbia University Medical Center, New York, US
| | - Mathew R Williams
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons.,Division of Cardiology, Columbia University Medical Center, New York, US
| | - Isaac George
- Division of Cardiothoracic Surgery, College of Physicians and Surgeons
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Cheema FH, Roberts HG. Staged percutaneous coronary intervention and minimally invasive valve surgery: results of a hybrid approach to concomitant coronary and valvular disease. J Thorac Cardiovasc Surg 2013; 145:1684. [PMID: 23679974 DOI: 10.1016/j.jtcvs.2012.12.092] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 12/10/2012] [Indexed: 11/17/2022]
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