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Hybrid intervention approach to coronary artery and valvular heart disease
Zachary Rosol1,2, Anupama Vasudevan3,4, Rahul Sawhney1,2
1Baylor University Medical Center, Dallas, Texas.
Insights
A hybrid approach combining percutaneous coronary intervention (PCI) and valve surgery is safe for patients with mixed heart disease. This strategy avoids stent thrombosis and restenosis, with all patients surviving one year.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Coronary angiography is standard for assessing coronary artery disease before valve surgery, often leading to combined procedures.
- A hybrid approach using percutaneous coronary intervention (PCI) before valve surgery is an alternative strategy.
Purpose of the Study:
- To evaluate the safety and outcomes of a hybrid approach involving planned PCI followed by surgical valve repair/replacement.
- To assess the primary outcome of stent thrombosis in patients undergoing this hybrid strategy.
Main Methods:
- Retrospective review of 24 patients undergoing planned PCI before surgical valve repair/replacement (Jan 2008-Dec 2016).
- Analysis of surgical complications, duration of dual antiplatelet therapy (DAPT) around surgery, stent thrombosis, and in-stent restenosis rates.
- Calculation of 1-year survival rates.
Main Results:
- Surgery occurred a median of 52.5 days post-PCI.
- Dual antiplatelet therapy (DAPT) was withheld for an average of 8 days pre-surgery and resumed 4 days post-surgery.
- No bleeding complications, stent thromboses, or restenosis events were observed; 92% of surgeries were minimally invasive.
- All patients survived the 1-year follow-up.
Conclusions:
- A heart team approach with preoperative PCI followed by staged, minimally invasive valve surgery is safe for mixed coronary and valvular heart disease.
- This hybrid strategy appears effective in preventing adverse cardiovascular events and warrants further investigation.
Abstract:
Coronary angiography is used to assess the burden of coronary artery disease prior to surgical valve repair/replacement and often leads to concomitant bypass and valve surgery. We sought to evaluate outcomes of an alternative, hybrid approach involving percutaneous coronary intervention (PCI) and valve surgery, assessing the rate of stent thrombosis as a primary outcome. We reviewed charts of consecutive patients who underwent planned PCI prior to surgical valve repair/replacement by a single surgeon from January 2008 to December 2016. We calculated rates of surgical complication, duration of dual antiplatelet therapy (DAPT) prior to surgery, and rates of stent thrombosis and in-stent restenosis. Twenty-four patients were included in this study. Surgery was performed a median of 52.5 days following PCI. DAPT was withheld an average of 8 days before and resumed an average of 4 days after surgery. Ninety-two percent of surgeries were minimally invasive. There were no bleeding complications, stent thromboses, or restenosis events. All patients survived the 1-year follow-up. For patients with mixed coronary and valvular heart disease, a heart team approach involving preoperative PCI followed by staged minimally invasive valvular surgery appears to be safe and warrants further exploration.
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