Landmark Hybrid Approach Study Conducted at Mount Sinai Medical Center

Sep 20, 2012, 16:34 ET from Mount Sinai Medical Center

MIAMI BEACH, Fla., Sept. 20, 2012 /PRNewswire-USNewswire/ -- The Journal of Thoracic and Cardiovascular Surgery (September 2012) has published a Mount Sinai Medical Center of Miami Beach study that reports the superiority of a hybrid approach to treating coronary valvular disease.  The study revealed that patients who had coronary artery intervention (stenting) combined with minimally invasive valve surgery had significantly better outcomes than patients who had standard sternotomy coronary bypass and valve surgery. Aimed at giving patients a safer treatment option for coronary valvular disease, the study is the largest of its kind to date.

When patients need to undergo a coronary artery bypass graft simultaneously with valve surgery, they tend to be sicker with an increased chance of morbidity. As such, researchers began exploring a strategy to dissociate these procedures into two, smaller staged procedures – minimally invasive valve surgery and percutaneous coronary intervention. When doctors use a minimally invasive surgical approach, patients have an increased chance of survival, fewer postoperative complications, faster recovery time and improved outcomes when compared with traditional median sternotomy surgery, where the entire chest cavity is opened.

"There is an increasing trend toward minimally invasive cardiac surgery, which is why the broad applicability of a hybrid approach is so appealing," said Dr. Joseph Lamelas, Chief of Cardiac Surgery at Mount Sinai and one of the principal investigators of the study. "Because our patients experienced better outcomes with this approach, we continued testing it beyond the first 65 cases described in this study. We now have done close to 200 cases, and we continue to see positive outcomes."

In addition to Dr. Lamelas, doctors who participated in the study included Gervasio Lamas, M.D. Chief, Columbia University Division of Cardiology at Mount Sinai; Orlando Santana, M.D., Director of Echocardiography Laboratory, Columbia University Division of Cardiology at Mount Sinai; Esteban Escolar, M.D., Director of Coronary Care, Columbia University Division of Cardiology at Mount Sinai; Michael Funk, M.D., and Carlos Zamora, M.D., cardiology fellow at Mount Sinai. 

The study evaluated the results of 65 patients who underwent the hybrid approach and compared them with the results of 52 patients who underwent the conventional approach.  Dr. Lamelas, who performs the highest volume of cardiac surgeries in Florida and has the best cardiac surgical outcomes in Florida (among institutions performing the highest volume of complex cases), performed all the minimally invasive cases.

When compared to those in the conventional group, patients in the hybrid approach group had significantly better outcomes that resulted in a:

  • Lower incidence of death (0 vs. 3.8%)
  • Lower incidence of kidney failure (1.5% vs. 17.3%)
  • Lower rate of postoperative complications (1.5% vs. 38.8%)
  • Shorter intensive care unit stay (50 hours v. 98 hours)
  • Shorter hospital stay (9 days vs. 15 days)

Overall, the Mount Sinai study demonstrated that minimally invasive valve surgery and percutaneous coronary intervention result in less trauma, faster recovery time and improved outcomes for patients with coronary and surgical valvular heart disease.

  • Mount Sinai Medical Center's study can be found in the Journal of Thoracic and Cardiovascular Surgery (September, 2012):
Staged percutaneous coronary intervention and minimally invasive valve surgery: Results of a hybrid approach to concomitant coronary and valvular disease

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Joanna Palmer

SOURCE Mount Sinai Medical Center