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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
Jarosław Stoliński, MD PhD, Dariusz Plicner, MD PhD, Grzegorz Grudzień, MD PhD, Janusz Andres, MD PhD, Bogusław Kapelak, MD PhD.
John Paul II Hospital, Jagiellonian University Cracow, Cracow, Poland.

OBJECTIVE: To report the results of hybrid aortic valve replacement through right anterior minithoracotomy (RAT-AVR)/PCI and conventional AVR/CABG surgery for patients with aortic valve and coronary artery disease.
METHODS: Analysis of prospectively gathered data of 187 patients: 86 hybrid and 101 conventional procedures. For 21 patients RAT-AVR was followed by PCI during the same session, in 65 patients RAT-AVR was performed within 90 days after PCI.
RESULTS: Hospital mortality in the AVR/CABG and RAT-AVR/PCI group was 3.9% and 1.2% respectively (P = 0.237). Both hospital and ICU stay were shorter in the RAT-AVR/PCI group (P < 0.001).
Complications occurred in 18.6% of patients in the RAT-AVR/PCI and 33.7% in the AVR/CABG group (P = 0.020). There was a reduced rate of deep (4.9% vs. 0.0%, P = 0.036) and superficial (9.9% vs. 2.3%, P = 0.035) chest wound infections, less postoperative low output syndrome (P = 0.033), as well as reduced postoperative blood loss and blood requirements (P < 0.001). There was no difference between groups regarding percentage of patients with postoperative renal failure, stroke, myocardial infarction or pacemaker implantation. Increased postoperative blood drainage was less frequent (3.5% vs. 22.8%, P < 0.001) and the mean volume of blood transfused was lower (342 ± 326 ml vs.166 ± 181ml) in the RAT-AVR/PCI group (P < 0.001). Two stage RAT-AVR/PCI was performed due to ACS (77.9%), one stage due to the intention to perform a minimal invasive procedure instead of conventional AVR/CABG (17.4%) or due to replacing CABG with PCI due to the lack of vascular grafts for CABG (4.6%). In 38.5% of patients from the two stage subgroup, antiplatelet therapy was stopped before RAT-AVR, 32.3% of patients from the two stage subgroup were on single and 29.2% on dual antiplatelet therapy until RAT-AVR, which had no influence on postoperative blood requirements or postoperative myocardial infarction (P < 0.001 and P = 0.050 respectively).
CONCLUSIONS: The hybrid procedure presented in our series favorable mortality and morbidity results may be an alternative to conventional AVR and CABG through full sternotomy in selected patients.

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