[Percutaneous coronary intervention and minimally invasive aortic valve replacement for patients with aortic valve disease and coronary artery disease].

OBJECTIVES

To report the results of hybrid approach combining percutaneous coronary intervention (PCI) and minimally invasive aortic valve replacement through right anterior minithoracotomy (RT-AVR) for patients with aortic valve disease and coronary artery disease.

MATERIALS AND

METHODS

Retrospective analysis of 53 hybrid RT-AVR/ PCI procedures where RT-AVR was performed first in the operating room and followed immediately by PCI performed in the catheterization laboratory.

RESULTS

Predicted with Euro- SCORE II and observed hospital mortality was 8.7±2.9% and 1.9% respectively. Hospital and intensive care unit length of stay were 5.6±2.4 and 1.8±1.4 days respectively. Biological aortic valve prosthesis was implanted in 40 (75.5%) patients. PCI of LAD was performed in 5 patients (9.4%), of Dg in 10 (18.9%) patients, of Mg or Cx in 21 (39.6%) patients, of PDA or RCA in 25 (47.2%) patients. Two vessels and three vessels PCI were performed in 5 (9.4%) and 3 (5.7%) patients respectively. DES were used during PCI in 42 (79.2%) patients. Dual antiplatelet therapy with 75 mg of Aspirin and 75 mg of Clopidogrel started after RTAVR/ PCI. Complications occurred in 16 (30.2%) patients after hybrid RT-AVR/PCI procedure. Prolonged above 24 hours mechanical ventilation time was necessary in 3 patients (5.7%). Renal insufficiency occurred in 4 (7.5%), stroke in 1 (1.9%) patient. Pacemaker was implanted in 2 (3.8%) patients after surgery. Conversion to conventional surgery through median sternotomy was performed in 1 patient (1.9%), surgical revision due to postoperative bleeding in 2 patients (3.8%). No perioperative myocardial infarction and no mediastinitis was diagnosed after RT-AVR/PCI procedure. Postoperative chest blood drainage was 245.0±181.0 ml. Red blood cells transfusion was required in 10 (18.9%) patients.

CONCLUSIONS

The hybrid RT-AVR/PCI procedure for these high risk patients with aortic valve disease and coronary artery disease presented in our series favourable mortality results compared to predicted with EuroSCORE II mortality for conventional cardiac surgery.