A comparison of surgical, total percutaneous, and hybrid approaches to treatment of combined coronary artery and valvular heart disease

Abstract

Purpose of review The purpose of this review is to compare outcomes of surgical valve replacement (SVR) and coronary artery bypass grafting (CABG), minimally invasive cardiac surgery (MICS) SVR and percutaneous coronary intervention (PCI), and transcatheter aortic valve replacement and PCI for the treatment of combined coronary artery disease (CAD) and valvular heart disease (VHD). Recent findings Several studies have attempted to identify key differences in outcomes with hybrid MICS SVR and PCI approaches to combined CAD and VHD. Recent studies have demonstrated that MICS SVR and PCI, when compared with conventional open SVR and CABG, demonstrate reduced or unchanged morbidity and mortality. However, the rate of bleeding in MICS SVR and PCI is consistently higher likely because of the effects of antiplatelet therapy. Summary A shift toward MICS has occurred in the preceding decades, with outcomes improving in recent years. With limited ability to perform CABG through MICS approaches, attempts have been made at hybrid procedures to address multiple presenting concerns while allowing for the benefits of MICS approaches. Hybrid MICS SVR and PCI approaches may provide suitable alternatives to traditional surgical approaches with reduced intra and postoperative morbidity and mortality, with the notable exception of bleeding complications.

Heart valve surgery and the obesity paradox: A systematic review

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Teaching heart valve surgery techniques using simulators: a systematic review

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What Can We Learn from the Past by Means of Very Long-Term Follow-Up after Aortic Valve Replacement?

“…The feedback of very long-term follow-up in these adult patients with congenital heart disease had a substantial impact on the timing and type of interventions [46]. Very longterm follow-up studies also provide a standard for comparing results of combinations of percutaneous and conventional treatments [47]. The connection with the initial decisionmaking on the indication for heart valve surgery and operating team usually fades with new generations.…”