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You are here: Contents > 2017 > Volume 26 Number 3 May 2017 > MISCELLANEOUS > A Staged Approach of Proximal Left Anterior Descending Coronary Artery Percutaneous Intervention Followed by Minimally Invasive Valve Surgery

A Staged Approach of Proximal Left Anterior Descending Coronary Artery Percutaneous Intervention Followed by Minimally Invasive Valve Surgery

Andrés M. Pineda1,4, Christos G. Mihos1, Juan P. Rodriguez-Escudero2, Joseph Lamelas3, Nirat Beohar1, Orlando Santana1

1Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, Florida, USA
2Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
3Department of Cardiac Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
4Electronic correspondence: andrespine@hotmail.com

Background and aim of the study: A subset of patients requiring coronary revascularization of the proximal left anterior descending coronary artery (LAD) and valve surgery may benefit from a staged approach, rather than combined median sternotomy coronary artery bypass graft (CABG) and valve surgery.

Methods: A retrospective evaluation was made of the outcomes of patients with significant proximal LAD and valvular heart disease undergoing a staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) at the authors’ institution between February 2009 and April 2014. A Kaplan-Meier analysis was performed to estimate mid-term survival.

Results: A total of 68 consecutive patients (mean age 75.2 ± 8.9 years) was identified. PCI was performed for one- or


two-vessel disease in 76.5% and 23.5% of the patients, respectively. Within a median of 39 days (IQR 11-62 days), 91.2% of patients underwent primary MIVS, and 8.8% underwent re-operative MIVS, of which 58 (85.3%) were single-valve and 10 (14.7%) were double-valve operations. At the time of surgery, 72.1% of the patients were receiving dual anti-platelet therapy. The 30-day mortality was 2.9%. At a mean follow up of 26 ± 16 months, 7.4% of the patients had a non-target vessel acute coronary syndrome, and the survival rate was 88.2%.

Conclusion: Among a select group of patients with proximal LAD and valvular disease, a staged approach of PCI followed by MIVS can be safely performed for primary or re-operative surgery, with excellent mid-term outcomes.

The Journal of Heart Valve Disease 2017;26:314-320


A Staged Approach of Proximal Left Anterior Descending Coronary Artery Percutaneous Intervention Followed by Minimally Invasive Valve Surgery

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