A study lead by researchers from the Mount Sinai Medical Center in Miami, USA, has found that patients with coronary valvular disease who were treated with a hybrid approach combining coronary artery stenting with minimally invasive valve surgery showed significantly better outcomes than patients who had standard sternotomy coronary bypass and valve surgery.
The single-center, retrospective study has been published in the September issue of the Journal of Thoracic and Cardiovascular Surgery.
When patients need to undergo a coronary artery bypass graft simultaneously with valve surgery, they tend to be sicker with an increased chance of morbidity. As such, Orlando Santana (director, Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute) and colleagues began exploring a strategy to dissociate these procedures into two, smaller staged procedures minimally invasive valve surgery and percutaneous coronary intervention.
“There is an increasing trend toward minimally invasive cardiac surgery, which is why the broad applicability of a hybrid approach is so appealing,” said Joseph Lamelas, chief of Cardiac Surgery at Mount Sinai Medical Center, Miami, USA, and one of the principal investigators of the study. “Because our patients experienced better outcomes with this approach, we continued testing it beyond the first 65 cases described in this study. We now have done close to 200 cases, and we continue to see positive outcomes.”
The study evaluated the results of 65 patients who underwent the hybrid approach from February 2009 to June 2011 (37 men and 28 women, mean age 75.4 ± 8 years) and compared them with the results of 52 patients (29 men and 23 women, mean age 73.8 ± 8.2 years) who underwent the conventional approach with coronary artery bypass grafting (CABG) and valve surgery.
When compared to those in the conventional group, patients in the hybrid approach group had significantly better outcomes that resulted in a:
- Lower incidence of death (0 vs. 3.8%)
- Lower incidence of kidney failure (1.5% vs. 17.3%)
- Lower rate of postoperative complications (1.5% vs. 30.8%)
- Shorter intensive care unit stay (50 hours v. 98 hours)
- Shorter hospital stay (9 days vs. 15 days)
The authors conclude: “In selected sites with a surgical team comfortable with minimally invasive surgery, a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery may be an effective approach for selected patients with suitable coronary and valvular anatomy”.
