First-in-man concomitant mitral valve replacement and coronary artery bypass grafting using a single minimally invasive access

Abstract

We present the case of a 78-year-old woman suffering from coronary artery disease and secondary severe mitral valve regurgitation due to left ventricular and annular distention. The interdisciplinary heart team recommended a simultaneous hybrid procedure consisting of minimally invasive direct coronary artery bypass grafting with subsequent transapical mitral valve replacement using the Tendyne prosthesis via the same small anterolateral thoracotomy. The operation was performed using a heart-team approach with close collaboration between heart surgeons and cardiologists in the hybrid operating theatre. The intra- and postoperative courses were uneventful. Predischarge transthoracic echocardiography on postoperative day 8 revealed the immaculate functioning of the implanted valve without para- or transvalvular insufficiency, a mean gradient of 2 mmHg, no left ventricular outflow tract obstruction and a stable ejection fraction of 50%. The combination of minimally invasive direct coronary artery bypass grafting revascularization with concomitant transapical mitral valve replacement is feasible and enables a further step towards minimally invasive therapy, even in complex situations. It shows that the modern heart-team approach exceeds mere decision making and expands towards a hybrid treatment for patients.

Keywords: Coronary artery disease; MIDCABG; Minimally invasive; Mitral regurgitation; TMVR; Valve replacement.