Skip Navigation LinksHome > July/August 2014 - Volume 9 - Issue 4 > Aortic Valve Replacement and Concomitant Right Coronary Arte...
Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery:
doi: 10.1097/IMI.0000000000000081
Original Articles

Aortic Valve Replacement and Concomitant Right Coronary Artery Bypass Grafting Performed via a Right Minithoracotomy Approach

Mihos, Christos G. DO*; Santana, Orlando MD*; Pineda, Andres M. MD*; La Pietra, Angelo MD; Lamelas, Joseph MD

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Objective: We present our experience of concomitant right coronary artery bypass grafting (CABG) and aortic valve replacement performed via a right minithoracotomy in patients with coronary lesions not amenable to percutaneous intervention.

Methods: A total of 17 patients underwent concomitant aortic valve replacement and right CABG between April 2008 and July 2013. A 5- to 6-cm minithoracotomy incision was made over the right second or third intercostal space, and the costochondral cartilage was transected. A saphenous vein bypass to the right coronary artery was then performed, initiating the anastomosis from the toe of the graft. Subsequently, the aortic valve was replaced using standard techniques.

Results: There were 6 men and 11 women. The median European System for Cardiac Operative Risk Evaluation II score mortality risk was 5% [interquartile range (IQR), 2%-8%]. The mean (SD) age was 77 (10) years, the left ventricular ejection fraction was 59% (8%), and the New York Heart Association functional class was 2.4 (0.8). One patient had a history of CABG. The mean (SD) cardiopulmonary bypass time was 168 (57) minutes, and the aortic cross-clamp time was 133 (36) minutes. Three patients underwent concomitant mitral valve surgery (replacement, 2; repair, 1). The median intensive care unit and hospital lengths of stay were 47 hours (IQR, 24–90) and 9 days (IQR, 5–13), respectively. There was one reoperation for bleeding, and there was one postoperative stroke. All patients were alive at a mean (SD) follow-up of 2 (1.1) years.

Conclusions: Aortic valve replacement with concomitant CABG performed via a right minithoracotomy approach is feasible.

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery


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