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Updated: Sep 20, 2025
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
First-in-man concomitant mitral valve replacement and coronary artery bypass grafting using a single minimally
Jules Miazza1, Luca Koechlin1, Raban V Jeger2
1Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
Insights
This study shows that combining minimally invasive bypass surgery with transapical mitral valve replacement is a feasible hybrid treatment. This approach offers a less invasive option for complex cardiac conditions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery disease (CAD) and severe mitral regurgitation (MR) often coexist, posing complex treatment challenges.
- Minimally invasive surgical techniques are advancing, aiming to reduce patient morbidity.
Observation:
- A 78-year-old woman with CAD and severe MR underwent a hybrid procedure combining minimally invasive direct coronary artery bypass grafting (MIDCAB) and transapical mitral valve replacement (MVR).
- The procedure was performed via a single anterolateral thoracotomy, utilizing a heart-team approach in a hybrid operating theatre.
Findings:
- The simultaneous hybrid procedure was technically successful and uneventful.
- Postoperative echocardiography confirmed excellent valve function with no regurgitation or obstruction and a stable ejection fraction of 50%.
Implications:
- This hybrid approach demonstrates feasibility for complex cardiac cases, advancing minimally invasive treatment options.
- The heart-team approach can extend beyond decision-making to encompass hybrid procedural execution for improved patient outcomes.
Abstract:
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.
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