Hybrid approach of percutaneous coronary intervention followed by minimally invasive valve operations

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.