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Published on: January 3, 2020
Hybrid revascularization using percutaneous coronary intervention and robotically assisted minimally invasive direct
Michael S Lee1, James R Wilentz, Raj R Makkar
1Cardiovascular Intervention Center, Cedars-Sinai Medical Center, 8631 W. Third St., Room 415E, Los Angeles, CA 90048, USA. michaelslee@pol.net
Insights
Hybrid revascularization (HR) offers a full revascularization option for multivessel coronary artery disease. This approach combines percutaneous coronary intervention (PCI) with minimally invasive direct coronary artery bypass (MIDCAB) for improved patient survival.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Hybrid revascularization (HR) integrates percutaneous coronary intervention (PCI) for non-left anterior descending (LAD) lesions with minimally invasive direct coronary artery bypass (MIDCAB) grafting of the LAD artery.
- The left internal thoracic artery (LITA) to LAD graft is crucial for long-term survival, boasting a 5-year patency rate of 95%.
Observation:
- This study evaluates HR as an alternative to conventional coronary artery bypass graft surgery for multivessel coronary artery disease.
- Early experiences with HR utilizing advanced PCI and robotic-assisted MIDCAB are presented.
Findings:
- HR aims to achieve complete revascularization while maintaining the survival benefits of LITA-LAD grafting.
- The combined approach seeks to leverage the advantages of minimally invasive PCI for non-LAD stenoses.
Implications:
- Hybrid revascularization may offer a viable, less invasive strategy for complex coronary artery disease.
- This approach could potentially improve patient outcomes by combining the strengths of surgical and percutaneous interventions.
Abstract:
Hybrid revascularization (HR) combines staged percutaneous coronary intervention (PCI) on stenoses in the non-left anterior descending (LAD) territories with minimally invasive direct coronary artery bypass (MIDCAB) using the left internal thoracic artery (LITA) to the LAD. The LITA-to-LAD graft, which has a 5-year patency rate of 95%, is the major determinant of the long-term survival for patients. Thus, HR aims to perform full revascularization without compromising the survival advantage of the LITA-to-LAD graft, while preserving the minimally invasive advantages associated with the percutaneous treatment of symptomatic coronary stenoses. We investigated whether HR was a valid alternative to conventional coronary artery bypass graft surgery in patients with multivessel coronary artery disease. We also present our early experiences with HR using a combined approach of advanced PCI and robotically-assisted MIDCAB.