Concomitant minithoracotomy aortic and mitral valve surgery: the minimally invasive "Miami Method".

A 69-year-old female patient with chronic renal failure requiring dialysis, insulin-dependent diabetes mellitus, hypertension and chronic obstructive pulmonary disease presented to the emergency room with epigastric pain and dyspnea upon exertion. Her initial work-up was for gastrointestinal disease. This was inconclusive. A cardiac work-up was subsequently performed. A cardiac catheterization demonstrated a high grade lesion of the proximal left anterior descending artery. Percutaneous coronary intervention with a drug eluting stent was successfully performed. An echocardiogram was also performed which demonstrated a 40% ejection fraction. There was severe aortic stenosis with a peak/mean gradient of 68/45 mmHg, respectively. In addition, she had severe mitral regurgitation with a posteriorly directed jet and moderate mitral annular calcification. She was considered a hybrid patient and taken to the operating room several weeks after the percutaneous coronary intervention on clopidogrel. She underwent a minimally invasive, minithoracotomy aortic valve replacement with a porcine bioprosthetic aortic valve and a complex mitral valve repair with anterior leaflet augmentation with autologous pericardium.