Mini Aortic Valve Replacement Followed By Percutaneous Coronary Intervention For Combined Coronary And Aortic Valve Disease
Alessandro Vivacqua1, Morgan Vonasek2, Jeffrey Altshuler1, Francis Shannon1, Marc Sakwa1.
1Beaumont Hospital, royal oak, MI, USA, 2Oakland University, royal oak, MI, USA.
Objectives: This study evaluates the safety and feasibility of a staged minimally invasive aortic valve replacement (MIAVR) followed by percutaneous coronary intervention (PCI) in patient with combined aortic valve and coronary artery disease. Methods: 28 patients with concomitant aortic valve and coronary artery disease who underwent MIAVR followed by planned PCI between April 2011 and April 2018 were retrospectively analyzed. Results: The majority of patients (53%) were male. The mean age was 75.1 ± 10 years. Valvular pathology was aortic stenosis in 25 patients and aortic insufficiency in 3 patients. All patients underwent a right anterior mini thoracotomy AVR. No 30 day mortality was observed, 1 patient required re-exploration for bleeding. The mean time between MIAVR and PCI was 16.5±15.9 days. PCI was performed for single vessel disease in 26 patients (93%) and for two vessel disease in 2 patients (7%). Most common treated vessel was the mid left anterior descending artery (46%), followed by right coronary artery (31%) and circumflex artery (23%). At a mean follow up of 45.4±22 months 3 patients required a repeat PCI, 1 patient died from intra cranial hemorrhage and 4 patients were lost to follow up. Conclusions: In a subset of patient with concomitant aortic valve and coronary artery disease, a staged hybrid approach with MIAVR followed by PCI is safe and might represent a feasible alternative to a more invasive procedure.
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