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Percutaneous Coronary Intervention Followed by Minimally Invasive Mitral Valve Surgery in Ischemic Mitral

Christos G Mihos1, Orlando Santana, Andrés M Pineda

  • 1From the *Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA; †Columbia University Medical Center, New York, NY USA; and ‡Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL USA.

Innovations (Philadelphia, Pa.)
|December 15, 2015
PubMed

Insights

A staged treatment for coronary artery disease and ischemic mitral regurgitation (IMR) involving percutaneous coronary intervention (PCI) followed by valve surgery shows low perioperative risk and good midterm survival.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Cardiac Valve Disease

Background:

  • Optimal treatment for coronary artery disease (CAD) with severe ischemic mitral regurgitation (IMR) is debated.
  • Combined surgical revascularization and valve repair/replacement via sternotomy is standard but carries high risk.
  • A staged approach using percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery may offer an alternative.

Purpose of the Study:

  • To evaluate the safety and efficacy of a staged treatment strategy for patients with CAD and severe IMR.
  • To compare this staged approach with traditional combined surgery.

Main Methods:

  • Retrospective analysis of 31 consecutive patients with CAD and severe IMR.
  • Patients underwent PCI followed by minimally invasive valve surgery between February 2009 and April 2014.
  • Data collected included demographics, procedural details, perioperative outcomes, and long-term survival.

Main Results:

  • Mean age was 72 years, LVEF 35%. STS predicted mortality was 5.1%.
  • PCI was performed first, followed by valve surgery within 36 days.
  • 30-day mortality was 3%, with low rates of acute kidney injury and no strokes. 5-year survival was 80%.

Conclusions:

  • A staged PCI and minimally invasive valve surgery approach is feasible for CAD patients with IMR.
  • This strategy demonstrates low perioperative morbidity and favorable midterm survival rates.
  • This approach may be a viable alternative to combined median sternotomy procedures.
Abstract

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