In the last decades, minimally invasive procedures have been developed in the therapy of aortic valve disorders. Recently, a novel concept of minimally invasive coronary revascularization in multivessel disease via left anterior mini-thoracotomy demonstrated promising results. Full median sternotomy, as a very invasive procedure, is the standard approach in concomitant surgical aortic valve replacement (sAVR) and coronary bypass grafting (CABG). The aim of our study was to show that the combination of minimal invasive aortic valve replacement via upper mini-sternotomy and coronary artery bypass grafting via left anterior mini-thoracotomy is feasible to avoid full median sternotomy. From 07/2022 to 09/2022, concomitant sAVR via upper partial sternotomy and CABG via left anterior mini-thoractomy on cardiopulmonary bypass and cardioplegic arrest was successfully performed in six consecutive patients (6 males; 69.8 ± 7.4 [60–79] years). All patients had severe aortic stenosis (MPG 45.5 ± 17.3 mmHg) and a significant coronary artery disease (three-vessel: 33%, two-vessel: 33%, one-vessel: 33%) with indication to cardiac surgery. Mean EuroScore2 was 3.2. All patients underwent successful less invasive concomitant biological sAVR and CABG. 67% of patients received a 25 mm, 33% received a 23 mm biological aortic valve replacement (Edwards Lifesciences Perimount). A total of 11 distal anastomoses (1.8 ± 1.0 [1–3] per patient) were performed by using left internal artery mammary (50%), radial artery (17%) and saphenous venous graft (67%) for grafting the left anterior descending (83%), circumflex (67%) and right (33%) coronary artery. Hospital mortality was 0%, stroke rate was 0%, myocardial infarction was 0% and repeat revascularization rate was 0%, ICU stay was 1 day in 83% of all patients and 50% left hospital within 8 days after surgery. Less invasive concomitant surgical aortic valve replacement and coronary artery bypass grafting using upper mini-sternotomy and left anterior mini-thoracotomy is feasible without compromises in surgical principles and complete coronary revascularization while maintaining thoracic stability by avoiding full median sternotomy.

在过去的几十年里，微创手术在主动脉瓣疾病的治疗中得到了发展。最近，通过左前小胸廓切开术治疗多支血管疾病的微创冠状动脉血运重建的新概念显示出有希望的结果。全正中胸骨切开术是一种侵入性很强的手术，是同时进行主动脉瓣置换术 (sAVR) 和冠状动脉旁路移植术 (CABG) 的标准方法。我们研究的目的是表明，通过上小型胸骨切开术进行微创主动脉瓣置换术和通过左前小型胸骨切开术进行冠状动脉旁路移植术的组合是可行的，以避免完全正中胸骨切开术。从 07/2022 到 09/2022，连续 6 名患者（6 名男性；69.8 ± 7.4 [60–79] 岁）成功进行了通过上部分胸骨切开术进行的 sAVR 和通过左前小型胸廓切开术进行体外循环和心脏停搏的 CABG 。所有患者均患有严重主动脉瓣狭窄（MPG 45.5 ± 17.3 mmHg）和明显的冠状动脉疾病（三支血管：33%，两支血管：33%，一支血管：33%），有心脏手术指征。EuroScore2 平均分为 3.2。所有患者均成功接受了微创同步生物 sAVR 和 CABG。67% 的患者接受了 25 毫米的生物主动脉瓣置换术，33% 的患者接受了 23 毫米的生物主动脉瓣置换术 (Edwards Lifesciences Perimount)。使用左乳内动脉（50%）、桡动脉（17%）和隐静脉移植物（67%）进行了总共 11 次远端吻合（每例 1.8 ± 1.0 [1-3] 例），用于移植左前动脉降冠状动脉（83%）、回旋支（67%）和右冠状动脉（33%）。住院死亡率为 0%，中风率为 0%，心肌梗死率为 0%，重复血运重建率为 0%，83% 的患者在 ICU 停留 1 天，50% 的患者在术后 8 天内出院。使用上小型胸骨切开术和左前小型胸廓切开术进行微创同步主动脉瓣置换术和冠状动脉旁路移植术是可行的，无需妥协手术原则和完整的冠状动脉血运重建，同时通过避免完全正中胸骨切开术来维持胸部稳定性。