title: Staged percutaneous coronary intervention and minimally invasive valve surgery: results of a hybrid approach to concomitant coronary and valvular disease.
abstract: BACKGROUND
  We compared a hybrid approach combining staged percutaneous coronary intervention (PCI) and minimally invasive valve surgery with concurrent valve surgery plus bypass via a median sternotomy approach.
  
  
  METHODS
  We retrospectively evaluated 65 consecutive patients with coronary disease and surgical valvular heart disease who underwent planned PCI followed within 60 days by minimally invasive valve surgery, and we compared them with 52 matched control patients who underwent conventional bypass grafting and valve surgery.
  
  
  RESULTS
  There were no in-hospital deaths in the hybrid group, compared with 2 (3.8%) observed in the matched group (P = .11). Death, renal failure, or stroke occurred in 1 (1.5%) in the hybrid group versus 15 (28.8%) in the conventional group (P = .001). The median number of days between PCI and surgery was 24 (interquartile range, 2.5-37). At surgery, 23 hybrid patients were receiving both aspirin and clopidogrel;, 18, clopidogrel alone; 4, aspirin alone; and 22 stopped the antiplatelet agents 5 days before the operation. Intensive care unit hours and total hospital length of stay, including PCI stay for the hybrid group, were less in the hybrid group (P = .001 for both comparisons). In the hybrid group, average blood use was 1.6 ± 1.6 U per patient versus 1.9 ± 2.4 U per patient with conventional surgery (P = .35. There were no reoperations for postoperative bleeding in the hybrid group compared with 2 (3.8%) in the conventional group (P = .43).
  
  
  CONCLUSIONS
  Staged PCI with minimally invasive valve surgery may offer an alternative to coronary bypass grafting with concurrent valve surgery and should be tested prospectively.
authors.affiliation: Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, FL, USA. osantana@msmc.com
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Michael
authors.initials: M
authors.lastname: Funk
authors.forename: Carlos
authors.initials: C
authors.lastname: Zamora
authors.forename: Esteban
authors.initials: E
authors.lastname: Escolar
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Joseph
authors.initials: J
authors.lastname: Lamelas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D001021:Aortic Valve / Q000601:surgery; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D005260:Female; D005431:Florida; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D056346:Sternotomy; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors