Author + information
- Andres M. Pineda,
- Juan Pablo Rodriguez-Escudero,
- Christos G. Mihos,
- Rama Krishna,
- Orlando Santana and
- Nirat Beohar
The subset of patients with severely reduced left ventricular systolic function requiring coronary revascularization and valve surgery are at increased risk for adverse post-operative outcomes. They may benefit from a hybrid approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS), rather than a combined median sternotomy coronary artery bypass graft and valve surgery.
We retrospectively evaluated the post-operative outcomes of such patients at our institution between February 2009 and June 2013. A Kaplan-Meier analysis was performed to estimate mid-term survival.
A total of 45 consecutive patients were identified, with a mean age of 75 ± 8 years, and a median LV ejection fraction of 33% (IQR 24-38). The PCI was performed for 1-vessel disease in 80% of the cases, drug-eluting stents were used in 71%, and the most common vessel treated was the LAD (58%). Within a median of 35 days (IQR 10-63), 76% of patients underwent primary and 24% underwent re-operative MIVS, of which 80% were single valve operations. At the time of surgery, 80% of the patients were on dual anti-platelet therapy. Post-operatively, acute renal failure requiring hemodialysis and reoperation due to bleeding occurred in 4.4% and 2.2%, respectively. There were no Q-wave myocardial infarctions or in-stent thrombosis. The 30-day mortality was 8.9%. At a mean follow-up period of 15 ± 13 months, 4.8% of the patients had a stroke, 7.1% had an acute coronary syndrome requiring target vessel revascularization, and the survival rate was 75.6%.
In a selected group of patients with reduced LV function and concomitant coronary artery and valvular disease, a hybrid approach of PCI followed by MIVS may be an attractive alternative to the combined median sternotomy coronary artery bypass graft and valve surgery.