The Best of Both Worlds: Staged Hybrid Approach to Complex Cardiac Disease in a Patient at High Surgical Risk

Abstract

For elderly patients with relevant comorbidities, combined cardiac surgery may be inadequate due to excessive surgical risk. Combining interventional valvular and surgical approaches may decrease surgical burden and operative risk. In the present case, we report a staged strategy of interventional mitral valve repair and secondary surgical aortic valve replacement and replacement of the ascending aorta in a patient at high risk for surgery. This hybrid approach allowed for substitution of one part of surgery by the relatively low-risk MitraClip procedure. For the future, increasing clinical importance of interventional valve therapies either for stand-alone or hybrid procedures can be anticipated.

Keywords

aortic valve - replacement - mitral valve repair

• References

• 1 Lee R, Li S, Rankin JS , et al; Society of Thoracic Surgeons Adult Cardiac Surgical Database. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg 2011; 91 (3) 677-684, discussion 684
• 2 Rankin JS, Hammill BG, Ferguson Jr TB , et al. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg 2006; 131 (3) 547-557
• 3 Franzen O, Baldus S, Rudolph V , et al. Acute outcomes of MitraClip therapy for mitral regurgitation in high-surgical-risk patients: emphasis on adverse valve morphology and severe left ventricular dysfunction. Eur Heart J 2010; 31 (11) 1373-1381
• 4 Angelini GD, Wilde P, Salerno TA, Bosco G, Calafiore AM. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet 1996; 347 (9003) 757-758
• 5 Leon MB, Smith CR, Mack MJ , et al; PARTNER Trial Investigators. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 2010; 363 (17) 1597-1607
• 6 Smith CR, Leon MB, Mack MJ , et al; PARTNER Trial Investigators. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011; 364 (23) 2187-2198
• 7 Conradi L, Seiffert M, Franzen O , et al. First experience with transcatheter aortic valve implantation and concomitant percutaneous coronary intervention. Clin Res Cardiol 2011; 100 (4) 311-316
• 8 Gummert JF, Funkat A, Osswald B , et al. EuroSCORE overestimates the risk of cardiac surgery: results from the national registry of the German Society of Thoracic and Cardiovascular Surgery. Clin Res Cardiol 2009; 98 (6) 363-369
• 9 Feldman T, Foster E, Glower DD , et al; EVEREST II Investigators. Percutaneous repair or surgery for mitral regurgitation. N Engl J Med 2011; 364 (15) 1395-1406