Comparison between Percutaneous Coronary Intervention versus Coronary
Artery Bypass Graft with Mitral Valve Replacement in Patients with
Single Vessel and Mitral Valve Disease
Abstract
Background: We compared staged percutaneous coronary
intervention (PCI) versus coronary artery bypass graft (CABG) with
mitral valve replacement (MVR) in patients with combined single vessel
and rheumatic mitral valve disease. Methods: We
prospectively evaluated 80 patients with combined single coronary artery
(requiring revascularization in non-LAD (Left Anterior Descending
artery) territory) and rheumatic mitral valve disease, divided into two
groups; Group I consisting of 40 patients who underwent staged PCI, and
mitral valve replacement 3 months later, and Group II consisting of 40
patients who underwent combined CABG (using saphenous venous graft) and
mitral valve replacement. We compared between both groups.
Results: The median aortic cross-clamp and
cardiopulmonary bypass times were 44 and 62 minutes for Group I, versus
60.5 and 82 minutes for Group II, that difference between groups is
statistically significant. 8 patients (20%) in Group I needed inotropic
support versus 12 patients (30%) in Group II, which is not
statistically significant. No patients in both groups did need any
mechanical support in the form of intra-aortic balloon pump (IABP). None
of the patients in both groups had intraoperative ECG
(electrocardiogram) changes in the form of ischemia or arrhythmias. The
median intensive care unit (ICU) length of stay (hours) and hospital
length of stay (days) were 39 hours and 5.5 days for Group I, versus
56.5 hours and 8.5 days for Group II, that difference between groups is
statistically significant. The median blood loss (ml) postoperatively
was 925 in group I versus 1075 in group II, which is statistically
significant. However, the rate of re-exploration for bleeding did not
differ significantly between both groups, with 1 case only (2.5%) in
group I versus 2 cases (5%) in group II, and no postoperative delayed
cardiac tamponade noted in any of the two groups. The post-operative
complications for groups I and II included 0 (0%) versus 3 (7.5%)
prolonged mechanical ventilation (>24 h), 0 (0%) versus 1
(2.5%) respiratory complications, 0 (0%) versus 2 (5%) wound
infection, 0 (0%) versus 1 (2.5%) cerebrovascular accidents, 2 (5%)
versus 1 (2.5%) acute kidney injury, respectively. There is no
statistically significant difference between both groups regarding these
previous post-operative complications. None of the patients in both
groups died within the first 30 days after surgery. None of the patients
in both groups had major cardiac events or CCU (Cardiac Care Unit)
admission. Regional wall motion abnormalities were noted in 15 patients
(37.5%) of group I versus 17 patients (42.5%) of group II, who all
undergone stress ECG, of whom 9 patients (22.5%) in group I versus 11
patients (27.5%) in group II showed positive results, and qualified for
diagnostic coronary angiography, which confirmed the need for
reoperation for myocardial ischemia/infarction within the first year of
follow up post-operatively in 4 patients (10%) of group I versus 8
patients (20%) of group II. All these follow up outcomes showed no
significant difference between both groups. Conclusions:
A staged approach of PCI followed by MVR is an alternative to the
conventional combined CABG and MVR, can be performed safely in some
patients with single coronary artery and MV disease, and is associated
with good short and follow-up outcomes