eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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3/2023
vol. 20
 
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abstract:
Original paper

Patients with aortic valve disease and coronary artery disease can benefit from a hybrid approach combining aortic valve replacement through right minithoracotomy and percutaneous coronary intervention

Jolanta Maria Rzucidło-Resil
1
,
Jarosław Stoliński
2, 3
,
Robert Musiał
4
,
Robert Sobczyński
2
,
Dariusz Plicner
2, 3

  1. Department of Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Krakow, Poland
  2. Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland
  3. Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
  4. Department of Anaesthesiology and Intensive Therapy, John Paul II Hospital, Krakow, Poland
Kardiochirurgia i Torakochirurgia Polska 2023; 20 (3): 146-154
DOI: https://doi.org/10.5114/kitp.2023.131954
Online publish date: 2023/10/30
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Introduction
Minimally invasive and hybrid procedures for patients with aortic valve pathology and coronary artery disease are innovative solutions.

Aim
To report the results of hybrid aortic valve replacement through right anterior minithoracotomy (RT-AVR)/percutaneous coronary intervention (PCI) and conventional aortic valve replacement (AVR)/coronary artery bypass grafting (CABG) surgery for patients with aortic valve and coronary artery disease.

Material and methods
Analysis of prospectively gathered data of 187 patients – 86 hybrid and 101 conventional procedures. For 21 patients, RT-AVR was followed by PCI during the same session, and for 65 patients RT-AVR was performed within 90 days of PCI.

Results
Hospital mortality in the AVR/CABG and RT-AVR/PCI groups was 3.0% and 1.2%, respectively (p = 0.237). Complications occurred in 18.6% of patients in the RT-AVR/PCI group and 33.7% in the AVR/CABG group (p = 0.020). Two-stage RT-AVR/PCI was performed due to ACS (100%); one-stage was due to the intention to perform a minimally invasive procedure instead of AVR/CABG (71.4%) or due to replacing CABG with PCI because of a lack of vascular grafts for CABG (19.1%). In 38.5% of patients from the two-stage subgroup, antiplatelet therapy was stopped before RT-AVR, 32.3% of patients from the two-stage subgroup were on single, and 29.2% on dual antiplatelet therapy until RT-AVR, which had no influence on postoperative blood requirements or postoperative myocardial infarction (p = 0.410 and p = 0.077, respectively).

Conclusions
The hybrid procedure presented in our series showed similar mortality and morbidity results and may be an alternative to conventional AVR and CABG through full sternotomy in selected patients.

keywords:

percutaneous coronary intervention, minimally invasive aortic valve surgery, hybrid cardiovascular procedures
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