Two-stage hybrid strategy for multivessel coronary artery disease and functional ischemic mitral regurgitation: A case series

Q4 Medicine Journal of Cardiology Cases Pub Date : 2024-09-01 DOI:10.1016/j.jccase.2024.05.004

Motoki Fukutomi MD, PhD , Kenji Wada MD , Tomoya Uchimuro MD , Mizuho Hoshina MD , Takayuki Onishi MD , Shuichiro Takanashi MD, PhD, FJCC , Tetsuya Tobaru MD, PhD, FJCC

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Abstract

The optimal treatment strategy of high surgical risk patients with multivessel coronary artery disease (CAD) and functional mitral regurgitation (MR) remains controversial. We present two cases in which two-stage hybrid treatment with prior transcatheter mitral valve edge-to-edge repair (TEER) followed by off-pump coronary artery bypass grafting (OPCAB) was successfully performed in patients with CAD and functional ischemic MR. In both cases, the patient showed good hemodynamic stability during OPCAB without an increase in MR. A two-stage hybrid strategy with prior TEER followed by OPCAB may be an ideal treatment option for high surgical risk patients with multivessel CAD and functional ischemic MR.

Learning objective

To recognize the effectiveness of a two-stage hybrid approach with transcatheter edge-to-edge repair and off-pump coronary artery bypass grafting in high surgical risk patients with multivessel coronary artery disease and functional mitral regurgitation.

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治疗多支血管冠状动脉疾病和功能性缺血性二尖瓣返流的两阶段杂交策略：病例系列

多支血管冠状动脉疾病（CAD）和功能性二尖瓣反流（MR）高手术风险患者的最佳治疗策略仍存在争议。我们介绍了两例成功实施两阶段混合治疗的病例，即先进行经导管二尖瓣边缘到边缘修补术（TEER），然后再进行体外冠状动脉旁路移植术（OPCAB），用于治疗患有冠状动脉疾病和功能性缺血性二尖瓣反流的患者。在这两个病例中，患者在 OPCAB 期间均表现出良好的血流动力学稳定性，而 MR 并未增加。学习目的认识经导管边缘到边缘修复术和体外循环冠状动脉旁路移植术两阶段混合方法在多支血管冠状动脉疾病和功能性二尖瓣反流的高手术风险患者中的有效性。

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