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Updated: Apr 21, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Aortic valve replacement and concomitant right coronary artery bypass grafting performed via a right minithoracotomy
Christos G Mihos1, Orlando Santana, Andres M Pineda
1From the Divisions of *Cardiology, and †Cardiac Surgery, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL USA.
Insights
This study shows that combining aortic valve replacement with coronary artery bypass grafting (CABG) using a minimally invasive right minithoracotomy is a feasible surgical approach. The procedure demonstrated good outcomes in patients with complex coronary artery disease.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Thoracic Surgery
Background:
- Coronary artery lesions not amenable to percutaneous intervention often require surgical revascularization.
- Aortic valve disease frequently coexists with coronary artery disease, necessitating combined surgical treatment.
- Minimally invasive approaches are increasingly favored for cardiac surgery to reduce morbidity.
Purpose of the Study:
- To evaluate the feasibility and outcomes of concomitant aortic valve replacement and right coronary artery bypass grafting (CABG) via a right minithoracotomy.
- To assess the safety and efficacy of this combined minimally invasive approach.
Main Methods:
- Seventeen patients underwent aortic valve replacement and right CABG through a 5- to 6-cm right minithoracotomy incision.
- The procedure involved transecting costochondral cartilage for access.
- Saphenous vein grafts were used for bypass to the right coronary artery, followed by standard aortic valve replacement.
Main Results:
- The median EuroSCORE II mortality risk was 5% in a cohort of 17 patients (mean age 77 years).
- Mean cardiopulmonary bypass and aortic cross-clamp times were 168 and 133 minutes, respectively.
- One reoperation for bleeding and one postoperative stroke occurred; all patients survived to a mean follow-up of 2 years.
Conclusions:
- Concomitant aortic valve replacement and CABG via a right minithoracotomy is a feasible surgical option.
- This minimally invasive approach can be safely performed in selected patients with combined aortic valve and coronary artery disease.
Objective:
We present our experience of concomitant right coronary artery bypass grafting (CABG) and aortic valve replacement performed via a right minithoracotomy in patients with coronary lesions not amenable to percutaneous intervention.
Methods:
A total of 17 patients underwent concomitant aortic valve replacement and right CABG between April 2008 and July 2013. A 5- to 6-cm minithoracotomy incision was made over the right second or third intercostal space, and the costochondral cartilage was transected. A saphenous vein bypass to the right coronary artery was then performed, initiating the anastomosis from the toe of the graft. Subsequently, the aortic valve was replaced using standard techniques.
Results:
There were 6 men and 11 women. The median European System for Cardiac Operative Risk Evaluation II score mortality risk was 5% [interquartile range (IQR), 2%-8%]. The mean (SD) age was 77 (10) years, the left ventricular ejection fraction was 59% (8%), and the New York Heart Association functional class was 2.4 (0.8). One patient had a history of CABG. The mean (SD) cardiopulmonary bypass time was 168 (57) minutes, and the aortic cross-clamp time was 133 (36) minutes. Three patients underwent concomitant mitral valve surgery (replacement, 2; repair, 1). The median intensive care unit and hospital lengths of stay were 47 hours (IQR, 24-90) and 9 days (IQR, 5-13), respectively. There was one reoperation for bleeding, and there was one postoperative stroke. All patients were alive at a mean (SD) follow-up of 2 (1.1) years.
Conclusions:
Aortic valve replacement with concomitant CABG performed via a right minithoracotomy approach is feasible.
