Department of Cardiac Surgery, University Hospital Basel, Basel, Switzerland.
Department of Cardiology, University Hospital Basel, Basel, Switzerland.
Eur J Cardiothorac Surg. 2022 Jun 15;62(1). doi: 10.1093/ejcts/ezac330.
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.
我们报告了一例 78 岁女性患者的病例，该患者患有冠状动脉疾病和继发性严重二尖瓣反流，这是由于左心室和环形扩张引起的。多学科心脏团队建议同时进行微创直接冠状动脉旁路移植术和经心尖二尖瓣置换术，使用 Tendyne 假体，通过相同的小前外侧开胸术。该手术采用心脏团队方法，心脏外科医生和心脏病专家在杂交手术室密切协作。术中及术后过程均无并发症。术后第 8 天的术前经胸超声心动图显示植入的瓣膜功能正常，无瓣周或瓣下反流，平均梯度为 2mmHg，无左心室流出道梗阻，射血分数稳定在 50%。微创直接冠状动脉旁路移植术再血管化与同期经心尖二尖瓣置换术相结合是可行的，即使在复杂情况下，也能进一步向微创治疗迈进。它表明现代心脏团队方法不仅仅是决策，而是向患者的杂交治疗扩展。
