Comparison between Percutaneous Coronary Intervention versus Coronary Artery Bypass Graft with Mitral Valve Replacement in Patients with Single Vessel and Mitral Valve Disease

Abstract

Combined coronary artery and mitral valve disease is a major cause of morbidity and mortality in the adult patient population. Traditional treatment involves combined mitral valve and CABG surgery using a median sternotomy. However, this combined surgical approach confers a higher risk when compared with isolated MV surgery. In some patients, the risks of such a combined surgical procedure may outweigh the benefits. Thus, the concept of parsing the total risk of a single major procedure to the lesser individual and summed risks of 2 smaller procedures—percutaneous coronary intervention (PCI) plus the mitral valve operation—has been applied in clinical practice and reported by various groups. The current study prospectively compared intraoperative and postoperative outcomes of staged PCI versus CABG with mitral valve replacement in patients with combined single vessel and rheumatic mitral valve disease. Our study included 80 patients with combined single coronary artery (requiring revascularization in non-LAD territory) and MV disease, divided into two groups; Group I consisting of 40 patients who underwent staged PCI, & mitral valve replacement 3 months later, and Group II consisting of 40 patients who underwent combined CABG (using saphenous venous graft) & mitral valve replacement. All group I patients were on dual antiplatelet therapy after PCI, which were stopped 5 days before MVR, and antithrombotics resumed within 24 to 48 hours after surgery.