Back to 2014 Annual Meeting Posters

OBJECTIVE: Coronary artery bypass grafting (CABG) with aortic valve replacement (AVR) or mitral valve replacement (MVR) is traditionally performed via sternotomy. Minimally invasive coronary artery bypass grafting (MICS) and minimally invasive valve surgery (MIVS) have been successfully performed independently. We present our series of 6 patients who underwent a combined MICS-MIVS via right anterior thoracotomy.
METHODS: Between January 2011 and June 2012 six patients underwent MICS-MIVS (four AVRs and two MVRs) via right anterior mini-thoracotomy for valve replacement and single vessel bypass. The surgeries were evaluated perioperatively for overall outcomes.
RESULTS: Six patients with an average age of 74±5 years underwent single vessel grafting using reversed saphenous vein graft to the right coronary artery with either AVR or MVR. Two patients were elective and 4 were emergent. Average cardiopulmonary bypass time was 170.5±30.3 minutes in the MICS-AVR group and 169.0±7.1 minutes for MICS-MVR and average aortic cross-clamp time was 121.8±35.9 minutes for MICS-AVR and 111.50±2.1 minutes for MICS-MVR. Three patients were discharged home in 5±0 days, one patient went to nursing home, and two were admitted to rehab. No patients required conversion to sternotomy or reoperation; one patient developed atrial fibrillation in the AVR group; and one was complicated by sepsis.
CONCLUSIONS: Concomitant valve replacement and single bypass grafting via right anterior mini-thoracotomy is a feasible surgical choice. Particularly when a non stentable lesion exists in a high risk patient. In the appropriate patient population, combined CABG and valve surgery can be safely performed via right anterior thoracotomy.