Abstract
In the last decades, minimally invasive procedures have been developed in the therapy of aortic valve disorders. Recently, a novel concept of minimally invasive coronary revascularization in multivessel disease via left anterior mini-thoracotomy demonstrated promising results. Full median sternotomy, as a very invasive procedure, is the standard approach in concomitant surgical aortic valve replacement (sAVR) and coronary bypass grafting (CABG). The aim of our study was to show that the combination of minimal invasive aortic valve replacement via upper mini-sternotomy and coronary artery bypass grafting via left anterior mini-thoracotomy is feasible to avoid full median sternotomy. From 07/2022 to 09/2022, concomitant sAVR via upper partial sternotomy and CABG via left anterior mini-thoractomy on cardiopulmonary bypass and cardioplegic arrest was successfully performed in six consecutive patients (6 males; 69.8 ± 7.4 [60–79] years). All patients had severe aortic stenosis (MPG 45.5 ± 17.3 mmHg) and a significant coronary artery disease (three-vessel: 33%, two-vessel: 33%, one-vessel: 33%) with indication to cardiac surgery. Mean EuroScore2 was 3.2. All patients underwent successful less invasive concomitant biological sAVR and CABG. 67% of patients received a 25 mm, 33% received a 23 mm biological aortic valve replacement (Edwards Lifesciences Perimount). A total of 11 distal anastomoses (1.8 ± 1.0 [1–3] per patient) were performed by using left internal artery mammary (50%), radial artery (17%) and saphenous venous graft (67%) for grafting the left anterior descending (83%), circumflex (67%) and right (33%) coronary artery. Hospital mortality was 0%, stroke rate was 0%, myocardial infarction was 0% and repeat revascularization rate was 0%, ICU stay was 1 day in 83% of all patients and 50% left hospital within 8 days after surgery. Less invasive concomitant surgical aortic valve replacement and coronary artery bypass grafting using upper mini-sternotomy and left anterior mini-thoracotomy is feasible without compromises in surgical principles and complete coronary revascularization while maintaining thoracic stability by avoiding full median sternotomy.
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References
Androshchuk V, Patterson T, Redwood SR (2023) Management of coronary artery disease in patients with aortic stenosis. Heart 109:322–329
Bonacchi M, Dokollari A, Parise O, Sani G, Prifti E, Bisleri G, Gelsomino S (2021) Ministernotomy compared with right anterior minithoracotomy for aortic valve surgery. J Thorac Cardiovasc Surg. https://doi.org/10.1016/j.jtcvs.2021.03.125
Tran Z, Hadaya J, Downey P, Sanaiha Y, Verma A, Shemin RJ, Benharsh P (2022) Staged versus concomitant transcatheter aortic valve replacement and percutaneous coronary intervention: a national analysis. JTCVS Open 10:148–161
Hasde AI, Saricaoglu MC, Kilickap M, Durdu MS (2022) Single or combined valve surgery and concomitant right coronary artery bypass through right anterior minithoracotomy approach. Thorac Cardiovasc Surg. https://doi.org/10.1055/s-0041-1731284
Murzi M, Cerillo AG, Bevilacqua S, Gilmanov D, Farneti P, Glauber M (2012) Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon’s experience with right minithoracotomy approach for aortic valve replacement. Eur J Cardiothorac Surg 41(06):1242–1246
Raja SG, Navaratnarajah M (2009) Impact of minimal access valve surgery on clinical outcomes: current best available evidence. J Card Surg 24(01):73–79
Babliak O, Demianenko V, Melnyk Y, Revenko K, Pidgayna L, Stohov O (2019) Complete coronary revascularization via left anterior thoracotomy. Innovations (Phila) 14(4):330–341
Dörge H, Sellin C, Belmenai A, Asch S, Eggebrecht H, Schächinger V (2022) Novel concept of routine total arterial coronary bypass grafting through a left anterior approach avoiding sternotomy. Heart Vessels 37(8):1299–1304
Sellin C, Asch S, Belmenai A, Mourad F, Voss M, Dörge H (2022) Early results of total coronary revascularization via left anterior thoracotomy. Thorac Cardiovasc Surg. https://doi.org/10.1055/s-0042-1758149
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W, ESC/EACTS Scientific Document Group (2022) 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 43(7):561–632
Bonzel T, Schächinger V, Dörge H (2016) Description of a Heart Team approach to coronary revascularization and its beneficial long-term effect on clinical events after PCI. Clin Res Cardiol 105(5):388–400
Neumann FJ, Sousa-Uva M, Ahlsson A, Alfonso F, Banning AP, Benedetto U, Byrne RA, Collet JP, Falk V, Head SJ, Jüni P, Kastrati A, Koller A, Kristensen SD, Niebauer J, Richter DJ, Seferovic PM, Sibbing D, Stefanini GG, Windecker S, Yadav R, Zembala MO, ESC Scientific Document Group (2019) 2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J 40(2):87–165
Beckmann A, Meyer R, Lewandowski J, Markewitz A, Blaßfeld D, Böning A (2022) German Heart Surgery Report 2021: the annual updated registry of the German society for thoracic and cardiovascular surgery. Thorac Cardiovasc Surg 70(5):362–376
Cosgrove DM 3rd, Sabik JF (1996) Minimally invasive approach for aortic valve operations. Ann Thorac Surg 62(2):596–597
Salenger R, Gammie JS, Collins JA (2016) Minimally invasive aortic valve replacement. J Card Surg 31(1):38–50
Hiraoka A, Kuinose M, Chikazawa G, Totsugawa T, Katayama K, Yoshitaka H (2011) Minimally invasive aortic valve replacement surgery: comparison of port-access and conventional standard approach. Circ J 75(7):1656–1660
Foghsgaard S, Gazi D, Bach K, Hansen H, Schmidt TA, Kjaergard HK (2009) Minimally invasive aortic valve replacement reduces atelectasis in cardiac intensive care. Acute Card Care 11(3):169–172
Doll N, Borger MA, Hain J, Bucerius J, Walther T, Gummert JF, Mohr FW (2002) Minimal access aortic valve replacement: effects on morbidity and resource utilization. Ann Thorac Surg 74(4):S1318-1322
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Sellin, C., Belmenai, A., Asch, S. et al. Novel concept of less invasive concomitant surgical aortic valve replacement and coronary artery bypass grafting avoiding full median sternotomy. Heart Vessels 38, 1298–1303 (2023). https://doi.org/10.1007/s00380-023-02281-6
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DOI: https://doi.org/10.1007/s00380-023-02281-6