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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

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: July/August 2014 - Volume 9 - Issue 4 - p 302–305
doi: 10.1097/IMI.0000000000000081
Original Articles

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.

From the Divisions of *Cardiology, and †Cardiac Surgery, Mount Sinai Heart Institute, Columbia University, Miami Beach, FL USA.

Accepted for publication December 31, 2013.

Disclosure: The authors declare no conflicts of interest.

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

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery