First-in-man concomitant mitral valve replacement and coronary artery bypass grafting using a single minimally invasive access.
Jules MiazzaLuca KoechlinRaban V JegerOliver T ReuthebuchPublished in: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery (2022)
We present the case of a 78-year-old woman suffering from coronary artery disease and secondary severe mitral valve regurgitation due to left ventricular and annular distention. The interdisciplinary heart team recommended a simultaneous hybrid procedure consisting of minimally invasive direct coronary artery bypass grafting with subsequent transapical mitral valve replacement using the Tendyne prosthesis via the same small anterolateral thoracotomy. The operation was performed using a heart-team approach with close collaboration between heart surgeons and cardiologists in the hybrid operating theatre. The intra- and postoperative courses were uneventful. Predischarge transthoracic echocardiography on postoperative day 8 revealed the immaculate functioning of the implanted valve without para- or transvalvular insufficiency, a mean gradient of 2 mmHg, no left ventricular outflow tract obstruction and a stable ejection fraction of 50%. The combination of minimally invasive direct coronary artery bypass grafting revascularization with concomitant transapical mitral valve replacement is feasible and enables a further step towards minimally invasive therapy, even in complex situations. It shows that the modern heart-team approach exceeds mere decision making and expands towards a hybrid treatment for patients.
Keyphrases
- mitral valve
- coronary artery bypass grafting
- minimally invasive
- left ventricular
- ejection fraction
- coronary artery disease
- aortic stenosis
- heart failure
- percutaneous coronary intervention
- left atrial
- aortic valve replacement
- transcatheter aortic valve implantation
- acute myocardial infarction
- quality improvement
- hypertrophic cardiomyopathy
- robot assisted
- cardiac resynchronization therapy
- atrial fibrillation
- palliative care
- decision making
- cardiovascular events
- end stage renal disease
- patients undergoing
- aortic valve
- chronic kidney disease
- type diabetes
- newly diagnosed
- computed tomography
- prognostic factors
- early onset
- transcatheter aortic valve replacement
- mesenchymal stem cells
- cardiovascular disease
- combination therapy
- thoracic surgery