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P51 HYBRYD TREATMENT FOR CORONARY ARTERY DISEASE CONCOMITANT WITH MINIMALLY INVASIVE CARDIAC VALVE SURGERY


 Cardiac valvular surgery concomitant with coronary artery bypass grafting has a higher mortality than isolated valve surgery. Therefore, a hybrid approach that combines the benefits of the low risk of percutaneous coronary angioplasty (PCI) with those of minimally invasive valve surgery, should be considered. At present, data on hybrid valve/PCI procedures are limited to clinical cases and small cases, in which the PCI procedure is usually followed by surgery after about 3 weeks. We report our experience in which valve surgery was first performed with a minimally invasive approach (minithoracotomy or ministernotomy), then followed by coronary revascularization with PCI, to reduce the risks of post–surgical bleeding due to anti–aggregating therapy, in a non–randomized but consecutive case. Between July 2019 and June 2021, 22 patients were treated. Median of the days between surgery and PCI was 8, median of total hospitalization was 13 days. In 6 patients the surgical approach was a ministernotomy, in 16 was performed a right minithoracotomy. In 14 (64%) patients PCI was performed on single coronary vessel, in 5 (22.5%) on 2 coronary vessels and in 3 (13.5%) on 3 coronary vessels. There were no reinterventions for postoperative bleeding. One patient presented gastro–intestinal bleeding from a colon polyp. No patients died during hospitalization, nor at the follow–up performed by telephone every 6 months. No patients required valve reintervention or coronary artery bypass during hospitalization or follow–up. One patient underwent a new PCI procedure at 7 months. In conclusion, the hybrid approach consisting of minimally invasive valve surgery followed by PCI may offer an alternative to the standard but more complex operation of coronary artery bypass grafting plus valve surgery through complete sternotomy.