Abstract 10460: Completeness of Revascularization and its Impact on the Outcomes of a Staged Approach of Percutaneous Coronary Intervention Followed by Minimally Invasive Valve Surgery for Patients With Concomitant Coronary Artery and Valvular Heart Disease
Introduction: A staged approach of percutaneous coronary intervention (PCI) followed by minimally invasive valve surgery (MIVS) is an alternative to the conventional combined coronary artery bypass and valve surgery for patients with concomitant coronary artery and valve disease.
Hypothesis: Incomplete revascularization may negatively affect clinical outcomes amongst patients with severe coronary artery and valve disease undergoing a staged approach of PCI followed by MIVS.
Methods: A total of 138 patients, who underwent a staged approach between January 2009 and June 2013, were retrospectively evaluated. Coronary angiograms were reviewed by 2 cardiologists blinded to outcomes and were then categorized into 2 groups: complete or incomplete revascularization, which was defined as ≥1 major epicardial coronary arteries of at least 2.0 mm diameter with ≥70% untreated obstruction after the index percutaneous coronary intervention and before minimally invasive valve surgery.
Results: Complete and incomplete revascularization was achieved in 105 (76%) and 33 (24%) patients, respectively (Table). The patients with incomplete revascularization had a lower ejection fraction, a higher STS score, and more prior myocardial infarctions and multi-vessel coronary artery disease. There were no differences in the post-operative complications, 30-day mortality, or 3-year survival (84 vs. 83%, p=0.68). After a median follow up of 29 months, incompletely revascularized patients had a higher incidence of acute coronary syndrome (2.9 vs. 12.9%, p=0.05).
Conclusions: In patients undergoing a staged approach of percutaneous coronary intervention followed by minimally invasive valve surgery, incomplete revascularization did not significantly impact the short or mid-term survival, but was associated with an increased incidence of acute coronary syndrome at follow up.
- Coronary artery disease
- Valvular heart disease
- percutaneous coronary intervention
- minimally invasive valve surgery
- staged approach
Author Disclosures: A.M. Pineda: None. R. Chandra: None. S.A. Gowani: None. C.G. Mihos: None. O. Santana: None. A.J. Kirtana: None. G.W. Stone: None. P. Kurlansky: None. C.R. Smith: None. N. Beohar: None.
- © 2015 by American Heart Association, Inc.