Hybrid coronary revascularization for the treatment of left main coronary stenosis: a feasibility study
S Tanveer Rab1, John S Douglas, Ellen Lyons
1Division of Cardiology, Andreas Gruentzig Cardiovascular Center of Emory University School of Medicine, Atlanta, Georgia, USA. srab@emory.edu
Insights
Hybrid coronary revascularization (HCR) is a feasible treatment for left main (LM) coronary artery stenosis. This approach combines durable bypass grafting with less invasive stenting, offering a viable alternative to traditional methods.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology
Background:
- Significant left main (LM) coronary artery stenosis traditionally treated with coronary artery bypass grafting (CABG).
- Percutaneous coronary intervention (PCI) for unprotected LM lesions is limited to high-risk patients.
- Hybrid coronary revascularization (HCR) for LM disease remains understudied.
Purpose of the Study:
- To assess the feasibility of a hybrid coronary revascularization (HCR) approach.
- To evaluate HCR for treating left main (LM) coronary artery stenosis.
Main Methods:
- Staged HCR in 22 patients with >70% LM stenosis.
- Minimally invasive left internal mammary artery (LIMA) to left anterior descending (LAD) bypass followed by LM and non-LAD PCI.
- Intravascular ultrasound for stent deployment confirmation and long-term follow-up.
Main Results:
- Successful LIMA patency (FitzGibbon A) in all cases.
- Successful LM stenting in all patients, with drug-eluting stents (DES) used in 21/22.
- No major adverse cardiac or cerebrovascular events at 30 days; 95% survival without reintervention at mean 38.8 months.
Conclusions:
- HCR is a feasible alternative for LM coronary disease.
- Combines long-term LIMA-LAD bypass durability with less invasive PCI.
- Offers a new treatment option for LM stenosis.
Objective:
To determine the feasibility of a hybrid coronary revascularization (HCR) approach for the treatment of left main (LM) coronary artery stenosis.
Background:
The recommended therapy for significant LM stenosis is coronary artery bypass grafting (CABG). Percutaneous coronary intervention (PCI) of unprotected LM lesions is reserved for patients at high risk for complications with CABG. HCR in LM disease has not been studied.
Methods:
Twenty-two consecutive patients with LM stenosis >70% underwent staged HCR. Following a robotic or thoracoscopic-assisted minimally invasive left internal mammary artery (LIMA) to left anterior descending artery (LAD) coronary bypass, PCI of the LM, and non-LAD targets was performed after angiographic confirmation of LIMA patency. Intravascular ultrasound confirmed optimal stent deployment. Thirty-day adverse outcomes and long term follow up was obtained.
Results:
In the 22 patients with LM lesions, 6 were ostial, 5 mid, and 11 distal. LIMA patency was FitzGibbon A in all cases. LM stenting was successful in all patients with drug-eluting stents (DES) placed in 21 of 22 cases. Three patients underwent stent implantation in the right coronary artery. There were no 30-day major adverse cardiac or cerebrovascular events. At a mean of 38.8 ± 22 months postprocedure, 21 patients were alive without reintervention; one death occurred at 454 days.
Conclusions:
HCR for LM coronary disease is a feasible alternative to CABG and unprotected LM PCI. This approach combines the long-term durability of a LIMA-LAD bypass with the less invasive option of PCI in non-LAD targets with DES.
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