Single or Combined Valve Surgery and Concomitant Right Coronary Artery Bypass through Right Anterior Minithoracotomy Approach

Abstract

Background Patients with combined valve and coronary artery disease are commonly performed by standard median sternotomy approach for coronary artery bypass grafting (CABG) and valve surgery. The purpose of this study is to describe our experience and show feasibility and safety of minimally invasive approach to single or combined valve pathology with single-vessel right coronary artery (RCA) disease, even if it is suitable to percutaneous coronary intervention.

Methods This retrospective study comprised 28 consecutive patients who underwent single or combined valve surgery concomitant right CABG through right anterior minithoracotomy between February 2018 and December 2020. Preoperative evaluation, intraoperative, and postoperative outcomes were reviewed and analyzed.

Results There were 12 men and 16 women. The mean age was 71.46 ± 6.82 years. Ten patients were in New York Heart Association class III or IV. The mean cardiopulmonary bypass and aortic cross-clamping times were 117.6 ± 21.3 and 98.1 ± 22.6 minutes, respectively. The mean time to extubation was 9.7 ± 5.6 hours, the mean intensive care unit stay was 37.4 ± 14.6 hours, and the mean hospital stay was 6.9 ± 3.2 days. There was one patient who underwent reoperation for bleeding. There were no instances of postoperative stroke, myocardial infarction, renal failure, or wound infection. The mean follow-up was 19 ± 2.4 months.

Conclusion Presence of RCA lesion is not a contraindication for minimally invasive approach in cases who underwent single or combined valve surgery. Combined valve surgery and right CABG via right anterior minithoracotomy are a safe and feasible option to standard median sternotomy surgery, even if RCA lesions seem suitable for stenting.

Keywords

minimally invasive surgery - valve surgery - CABG

Publikationsverlauf

Eingereicht: 19. März 2021

Angenommen: 04. Mai 2021

Artikel online veröffentlicht:
08. Februar 2022

• References

• 1 Murzi M, Cerillo AG, Bevilacqua S, Gilmanov D, Farneti P, Glauber M. Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon's experience with a right minithoracotomy approach for aortic valve replacement. Eur J Cardiothorac Surg 2012; 41 (06) 1242-1246
• 2 Raja SG, Navaratnarajah M. Impact of minimal access valve surgery on clinical outcomes: current best available evidence. J Card Surg 2009; 24 (01) 73-79
• 3 Cohn LH, Adams DH, Couper GS. et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997; 226 (04) 421-426 , discussion 427–428
• 4 Navia JL, Cosgrove III DM. Minimally invasive mitral valve operations. Ann Thorac Surg 1996; 62 (05) 1542-1544
• 5 Schmitto JD, Mokashi SA, Cohn LH. Minimally-invasive valve surgery. J Am Coll Cardiol 2010; 56 (06) 455-462
• 6 Lamelas J, Sarria A, Santana O, Pineda AM, Lamas GA. Outcomes of minimally invasive valve surgery versus median sternotomy in patients age 75 years or greater. Ann Thorac Surg 2011; 91 (01) 79-84
• 7 Wang L, Li B, Liu C, Rong T, Yu Y, Gu C. Short- and medium-term effects of combined mitral valve surgery and coronary artery bypass grafting versus coronary artery bypass grafting alone for patients with moderate ischemic mitral regurgitation: a meta-analysis. J Cardiothorac Vasc Anesth 2016; 30 (06) 1578-1586
• 8 Seipelt RG, Schoendube FA, Vazquez-Jimenez JF, Doerge H, Voss M, Messmer BJ. Combined mitral valve and coronary artery surgery: ischemic versus non-ischemic mitral valve disease. Eur J Cardiothorac Surg 2001; 20 (02) 270-275
• 9 Mihos CG, Santana O, Pineda AM, La Pietra A, Lamelas J. Aortic valve replacement and concomitant right coronary artery bypass grafting performed via a right minithoracotomy approach. Innovations (Phila) 2014; 9 (04) 302-305
• 10 Brinster DR, Byrne M, Rogers CD. et al. Effectiveness of same day percutaneous coronary intervention followed by minimally invasive aortic valve replacement for aortic stenosis and moderate coronary disease (“hybrid approach”). Am J Cardiol 2006; 98 (11) 1501-1503
• 11 Santana O, Funk M, Zamora C, Escolar E, Lamas GA, Lamelas J. Staged percutaneous coronary intervention and minimally invasive valve surgery: results of a hybrid approach to concomitant coronary and valvular disease. J Thorac Cardiovasc Surg 2012; 144 (03) 634-639
• 12 Gumus F, Hasde AI, Bermede O, Kilickap M, Durdu MS. Multiple valve implantation through a minimal invasive approach: comparison of standard median sternotomy and right anterior thoracotomy. Heart Lung Circ 2020; 29 (09) 1418-1423
• 13 Lewis CT, Stephens RL, Cline JL, Tyndal CM. Concurrent minimally invasive aortic valve replacement and coronary artery bypass via limited right anterior thoracotomy. Innovations (Phila) 2015; 10 (04) 273-275
• 14 Baran C, Durdu MS, Gumus F. et al. Sutureless aortic valve replacement with concomitant valvular surgery. J Thorac Cardiovasc Surg 2018; 155 (06) 2414-2422
• 15 Cao D, Chiarito M, Pagnotta P, Reimers B, Stefanini GG. Coronary revascularization in transcatheter aortic valve implantation candidates: why, who, when?. Interv Cardiol 2018; 13 (02) 69-76
• 16 Byrne JG, Leacche M, Unic D. et al. Staged initial percutaneous coronary intervention followed by valve surgery (“hybrid approach”) for patients with complex coronary and valve disease. J Am Coll Cardiol 2005; 45 (01) 14-18
• 17 Smit PJ, Shariff MA, Nabagiez JP, Khan MA, Sadel SM, McGinn Jr JT. Experience with a minimally invasive approach to combined valve surgery and coronary artery bypass grafting through bilateral thoracotomies. Heart Surg Forum 2013; 16 (03) E125-E131