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Updated: Jun 1, 2025
Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
Electrocoagulation-free strategy in minimally invasive direct coronary artery bypass with hybrid revascularisation -
Carla L Schuering1, Leonhard Wert2, Johanna K R von Mackensen2
1Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Augustenburger Platz 1, 13353, Berlin, Germany. carlalouise.schuering@st.hunimed.eu.
Insights
This study details a novel hybrid coronary revascularisation approach for a complex patient with multivessel coronary artery disease. A minimally invasive direct coronary artery bypass (MIDCAB) procedure was successfully performed without electrocoagulation, a first for such cases.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Hybrid coronary revascularisation combines minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous coronary intervention (PCI) for multivessel disease.
- A 63-year-old female presented with triple-vessel coronary artery disease, including left main ostial stenosis and moderate right coronary artery stenosis.
- The patient had significant comorbidities and a high surgical risk (EuroSCORE II: 4.27%), with a specific contraindication for electrocoagulation due to a cochlear implant.
Observation:
- The patient had chronic obstructive pulmonary disease, renal impairment, extracardiac arteriopathy, prior gastrointestinal surgeries, and paroxysmal atrial fibrillation.
- A contraindication for electrocoagulation was noted due to the patient's cochlear implant, necessitating modification of the standard MIDCAB procedure.
Findings:
- A successful minimally invasive direct coronary artery bypass (MIDCAB) procedure was performed, omitting electrocoagulation.
- This represents the first reported instance of a successful MIDCAB procedure without electrocoagulation in a multimorbid patient with multivessel coronary disease undergoing hybrid revascularisation.
Implications:
- This case demonstrates the feasibility of adapting MIDCAB procedures in patients with specific contraindications, such as cochlear implants.
- The findings suggest that hybrid coronary revascularisation strategies can be tailored to manage complex multivessel disease in high-risk, multimorbid patients.
- This approach expands the options for coronary revascularisation in challenging patient profiles.
Background:
Hybrid coronary revascularisation benefits patients with multivessel disease, as it amalgamates the minimally invasive direct coronary artery bypass (MIDCAB) procedure and percutaneous coronary intervention (PCI). We present a 63-year-old female with triple-vessel coronary artery disease including marked ostial stenosis of the left main coronary artery, as well as moderate stenosis of the right coronary artery. The risk of death following heart surgery (EuroSCORE II) is 4.27%. The patient exhibited multiple morbidities including chronic obstructive pulmonary disease, renal impairment, extracardiac arteriopathy, and multiple prior gastrointestinal surgeries, as well as a recent episode of paroxysmal atrial fibrillation. A MIDCAB procedure without electrocoagulation was stipulated by the ENT specialist due to the patient's cochlear implant.
Conclusion:
A successful MIDCAB procedure omitting electrocoagulation was performed for the first time for multivessel coronary disease in a multimorbid patient as part of a hybrid approach.
