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.