title: Percutaneous Coronary Intervention Followed by Minimally Invasive Mitral Valve Surgery in Ischemic Mitral Regurgitation.
abstract: OBJECTIVE
  The optimal treatment strategy in patients with coronary artery disease and ischemic mitral regurgitation (IMR) remains controversial. A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery, rather than combined median sternotomy coronary artery bypass and valve surgery, may be a viable alternative.
  
  
  METHODS
  We retrospectively evaluated 31 consecutive patients with coronary artery disease and severe IMR who underwent a staged procedure at our institution between February 2009 and April 2014.
  
  
  RESULTS
  The mean ± SD age, preoperative left ventricular ejection fraction, and mitral regurgitation grade were 72 ± 7 years, 35% ± 11%, and 3.6 ± 0.6, respectively. The mean ± SD Society of Thoracic Surgeons-predicted mortality score was 5.1% ± 4.2%. Percutaneous coronary intervention was performed for 1- and 2-vessel disease in 22 patients (71%) and 9 patients (29%), respectively, with 23 patients (74%) having drug-eluting stents placed. Minimally invasive valve surgery was performed within a median of 36 days after PCI, with 61% of the patients being on dual antiplatelet therapy. Postoperatively, there was 1 case of acute kidney injury, 1 case of reoperation for bleeding, and no cerebrovascular accidents. The 30-day mortality was 3%. The median total hospital length of stay was 8 days (interquartile range, 7-10). At a mean ± SD follow-up of 2.4 ± 1.6 years, 2 patients required PCI for target-vessel revascularization. Actuarial survival at 1 and 5 years was 84% and 80%, respectively.
  
  
  CONCLUSIONS
  A staged approach in patients with coronary artery disease and IMR can be performed with a low perioperative morbidity and good midterm survival.
authors.affiliation: From the *Division of Cardiology, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL USA; †Columbia University Medical Center, New York, NY USA; and ‡Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, FL USA.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Pineda
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: Frederick
authors.initials: F
authors.lastname: Hasty
authors.forename: Nirat
authors.initials: N
authors.lastname: Beohar
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000601:surgery; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007511:Ischemia / Q000601:surgery; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000473:pathology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome