Conclusions
In conclusion, 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. As per our study,
it was associated with: (I) significantly less operative time, (II)
significantly faster post-operative recovery, as evidenced by a shorter
intensive care unit and hospital lengths of stay, (III) significantly
less bleeding & blood transfusions, with no significant difference
regarding re-exploration for bleeding, (IV) comparable morbidity,
mortality, and early follow-up outcomes. Although our valve-PCI cohort
primarily underwent surgery through conventional sternotomy, we expect
to see even greater clinical benefits with regard to lower transfusion,
pain, and length of stay when undergoing minimally invasive, robotic, or
small incision valvular surgery.
Nevertheless, important questions remain, including the optimal timing
of the individual procedures, and the optimal antiplatelet therapy after
PCI. With ongoing advances in stent technology, procedural techniques,
and anticoagulation strategies, as well as the accumulation of long-term
outcomes data, hybrid approaches to concomitant coronary artery and
mitral valve disease will likely become increasingly common. Tailoring
the approach to individual patient pathology and comorbidities is
feasible and offers potentially better treatment paradigms.