Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up
Friedrich-Christian Riess1, Ralf Bader, Peter Kremer
1Heart Center Hamburg, Albertinen-Krankenhaus, Department of Cardiac Surgery, Hamburg-Othmarschen, Germany. friedrich-christian.riess@albertinen.de
Insights
Hybrid revascularization (HyR) offers a safe and effective treatment for multivessel coronary artery disease, avoiding cardiopulmonary bypass. This minimally invasive approach shows excellent early and good midterm outcomes, particularly benefiting elderly patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Minimally Invasive Procedures
Background:
- Hybrid revascularization (HyR) combines minimally invasive bypass grafting with catheter-based interventions.
- This approach aims to mitigate the risks associated with cardiopulmonary bypass (CPB).
- Investigated clinical outcomes in 57 patients with multivessel disease over four years.
Purpose of the Study:
- To evaluate the clinical follow-up of patients undergoing hybrid revascularization.
- To assess the safety and efficacy of HyR in treating multivessel coronary artery disease.
- To determine the benefits of avoiding CPB in selected patient populations.
Main Methods:
- 57 patients with coronary artery disease underwent off-pump LIMA-to-LAD bypass and angioplasty/stenting of other lesions.
- Procedures were performed between January 1997 and January 2001.
- Clinical data included early postoperative assessment, 6-month angiography, and patient interviews.
Main Results:
- All procedures were completed without major complications; one early LIMA occlusion occurred.
- At 6-month follow-up (34 patients), LIMA bypass was patent in 33.
- 8 in-stent restenoses were managed with re-intervention or medical therapy; one late death from hemorrhage.
Conclusions:
- Hybrid revascularization is effective and secure for selected multivessel disease patients, including those with left main stem stenosis.
- HyR demonstrates excellent early and good midterm results.
- Elderly patients with comorbidities particularly benefit from avoiding CPB.
Background:
Hybrid revascularization (HyR), combining minimally invasive left internal mammary artery (LIMA) bypass grafting to the left anterior descending coronary artery (LAD) and catheter interventional treatment of the remaining coronary lesions, avoids the disadvantages associated with cardiopulmonary bypass (CPB). We investigated the clinical follow-up of 57 patients with multivessel disease undergoing this procedure in the last 4 years.
Methods:
Between January 1997 and January 2001, 57 consecutive patients (41 men and 16 women, aged 65.7 +/- 7.9 years) with coronary artery disease (two-vessel, n = 34; three-vessel, n = 23) were treated with off-pump LIMA-to-LAD bypass combined with balloon angioplasty and stenting of the remaining significantly obstructed (> 50%) coronary vessels. Clinical follow-up data included a early postoperative and a 6-month control angiography and a patient interview in January 2001.
Results:
All patients underwent LIMA-to-LAD bypass-grafting and balloon angioplasty in 72 coronary lesions without procedural-related complications. However, one early LIMA bypass occlusion was documented during coronary angiography. Postoperatively no deterioration of preexistent organ dysfunction was observed in any patient. The mean follow-up was 100.7 +/- 37.9 weeks in 55 of 57 patients (97%). Control angiography 6 months after HyR (n = 34) revealed a patent LIMA bypass in 33 patients and 8 in-stent restenoses (> 50%) in the coronary arteries that were treated interventionally by re-PTCA (n = 6) or by conventional CABG (n = 1). In 1 patient medical treatment resulted in significant reduction of angina so no further intervention was considered necessary. After HyR 1 patient died 18 months later of an intracerebral hemorrhage. All other patients are alive and doing well.
Conclusions:
Our results indicate that in selected patients with multivessel disease including left main stem stenosis HyR is an effective and secure procedure with excellent early and good midterm results. Especially elderly patients with severe concomitant diseases appear to benefit from this approach by avoiding CPB.
More Related Videos
09:12Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
Related Concept Videos
01:30Coronary Artery Disease I: Introduction
01:30Coronary Artery Disease III: Clinical Manifestations
01:26Coronary Artery Disease IV: Preventive Measures
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies