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Outcomes of a Combined Approach of Percutaneous Coronary Revascularization and Cardiac Valve Surgery

Santana, Orlando MD; Singla, Sandeep MD; Mihos, Christos G. DO; Pineda, Andrés M. MD; Stone, Gregg W. MD; Kurlansky, Paul A. MD; George, Isaac MD; Kirtane, Ajay J. MD; Smith, Craig R. MD; Beohar, Nirat MD

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: January/February 2017 - Volume 12 - Issue 1 - p 4–8
doi: 10.1097/IMI.0000000000000342
Review Article

A subset of patients requiring coronary revascularization and valve surgery may benefit from a combined approach of percutaneous coronary intervention (PCI) and valve surgery, as opposed to the standard median sternotomy approach of combined coronary artery bypass and valve surgery. To evaluate its potential benefits and limitations, a literature search was performed using PubMed, EMBASE, Ovid, and the Cochrane library, through March 2016 to identify all studies involving a combined approach of PCI and valve surgery in patients with coronary artery and valvular disease. There were five studies included in the study with a total of 324 patients, of which 75 (23.1%) had a history of previous cardiac surgery. The interval between PCI and surgery ranged from simultaneous intervention to a median of 38 days (interquartile range, 18–65 days). The surgical approach performed consisted of a minimally invasive one or median sternotomy. There were 275 single valve surgery (84.9%) and 49 double-valve surgery (15.1%) with a 30-day mortality ranging from 0% to 5.5%. The 1-year survival ranged from 78% to 96%, and the follow-up period ranged from 1.3 to 5 years. Herein, we present a review of the literature using this technique.

From the *Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL USA; and †Columbia University Medical Center, New York, NY USA.

Accepted for publication December 19, 2016.

Disclosures: Gregg W. Stone, MD, receives consulting fees from Velomedix, Toray, Matrizyme, Miracor, TherOx, Reva, V-Wave, Vascular Dynamics, Ablative Solutions, Neovasc, and Medical Development Technologies, serving as a consultant on prasugrel patent litigation paid for by Lupin Pharmaceuticals, and holding equity in the MedFocus family of funds, Guided Delivery Systems, Micardia, Vascular Nanotransfer Technologies, Cagent, Qool Therapeutics, Caliber Therapeutics, Aria, and the Biostar family of funds. Isaac George, MD, is a consultant for Edwards Lifesciences Corp, Irvine, CA USA; Medtronic, Inc, Minneapolis, MN USA; Bolton Medical, Sunrise, FL USA, and Tendyne Medical Group, Roseville, MN USA. Ajay J. Kirtane, MD, is a consultant for Boston Scientific, Corp, Marlborough, MA USA, Medtronic, Inc, Minneapolis, MN USA, Abbott Vascular, Temecula, CA USA, Abiomed, Danvers, MA USA; St. Jude Medical, Inc, St. Paul, MN USA, and Eli Lilly, Indianapolis, IN USA. Orlando Santana, MD, Sandeep Singla, MD, Christos G. Mihos, DO, Andrés M. Pineda, MD, Paul A. Kurlansky, MD, Craig R. Smith, MD, and Nirat Beohar, MD, declare no conflicts of interest.

Address correspondence and reprint requests to Orlando Santana, MD, Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, 4300 Alton Rd, Miami Beach, FL 33140 USA. E-mail:

©2017 by the International Society for Minimally Invasive Cardiothoracic Surgery