Key result
Single-stage CABG with combined mitral and tricuspid valve surgery enables successful recovery in complex endocarditis.
Why the study?
Concomitant multivessel CAD and severe multivalvular heart disease in elderly patients with a background of infective endocarditis present a major surgical challenge.
Does combined single-stage coronary artery bypass grafting, bioprosthetic mitral valve replacement, and tricuspid De Vega annuloplasty provide effective clinical stabilisation in an elderly patient with severe multivessel coronary artery disease, multivalvular heart disease, and healed infective endocarditis?
Case Report (n=1)
No
Does combined single-stage coronary artery bypass grafting, bioprosthetic mitral valve replacement, and tricuspid De Vega annuloplasty provide effective clinical stabilisation in an elderly patient with severe multivessel coronary artery disease, multivalvular heart disease, and healed infective endocarditis?
Combined single-stage coronary artery bypass grafting, bioprosthetic mitral valve replacement, and tricuspid De Vega annuloplasty can achieve effective clinical stabilisation in a high-risk elderly patient with complex multivessel coronary artery disease, multivalvular pathology, and healed infective endocarditis.
Answers are grounded in this paper and cite their sources.
May inform surgical planning in select elderly patients with healed endocarditis; leaves open need for larger studies to assess generalizability.
Background Concomitant multivessel coronary artery disease (CAD) and severe multivalvular heart disease in elderly patients with a background of infective endocarditis present a major surgical challenge. Case presentation A 76-year-old woman with hypertension, type 2 diabetes, chronic kidney disease, NYHA class III heart failure, and a history of subendocardial myocardial infarction with a non-growing mitral vegetation (healed infective endocarditis) presented with refractory unstable angina and acute heart failure. Coronary angiography demonstrated severe multivessel CAD (right coronary artery 70–80% stenosis; circumflex 60–65% distal stenosis with aneurysmal expansion; diffuse left anterior descending disease up to 80% stenosis). Echocardiography revealed severe mitral regurgitation with valve calcification and tricuspid insufficiency. The patient underwent urgent combined single-stage cardiac surgery: coronary artery bypass grafting (aorta-to-RCA) with a saphenous vein graft, mitral valve replacement with a 31 mm St. Jude Medical bioprosthesis, and tricuspid De Vega suture annuloplasty under cardiopulmonary bypass (CPB time 178 min, aortic cross-clamp time 111 min). Conclusion The patient made an excellent recovery following intensive care, targeted antibiotic therapy, blood transfusion, and respiratory exercises, and was discharged in stable condition on postoperative day 24. Single-stage revascularisation, bioprosthetic valve replacement, and tricuspid annuloplasty provided effective clinical stabilisation in a high-risk elderly patient with complex CAD and multivalvular pathology.
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GABAIDZE et al. (2026) conducted a case report in Severe multivessel coronary artery disease, severe mitral regurgitation, tricuspid regurgitation, and healed infective endocarditis (n=1). Combined single-stage coronary artery bypass grafting (aorta-to-RCA), bioprosthetic mitral valve replacement (31 mm St. Jude Medical), and tricuspid De Vega suture annuloplasty was evaluated on Postoperative clinical recovery and survival to hospital discharge. Single-stage CABG, bioprosthetic mitral valve replacement, and tricuspid De Vega annuloplasty resulted in clinical stabilization and discharge on postoperative day 24 in a 76-year-old woman.
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