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Beating heart operations including hybrid revascularization: initial experiences
F C Riess1, J Schofer, P Kremer
1Department of Cardiac Surgery, Albertinen-Krankenhaus, Hamburg, Germany.
Insights
Beating heart surgery using a new stabilizer is safe and effective for coronary artery disease, including left main stenosis. This hybrid approach combines bypass grafting with angioplasty for selected patients.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Interventional Cardiology
Background:
- Investigated outcomes of 45 patients with coronary artery disease undergoing beating heart operations.
- Utilized a novel stabilizing device for cardiac procedures.
- Focused on patients with one- to three-vessel coronary artery disease.
Purpose of the Study:
- To evaluate the safety and efficacy of beating heart surgery.
- To assess the outcomes of a hybrid revascularization approach.
- To compare this technique with conventional coronary artery bypass grafting.
Main Methods:
- Performed Left Internal Mammary Artery-to-Left Anterior Descending (LIMA-to-LAD) revascularization.
- Executed LIMA-to-LAD alone in 31 patients.
- Conducted hybrid procedures (LIMA-to-LAD + angioplasty/stenting) in 14 patients.
Main Results:
- All 45 patients had successful LIMA-to-LAD procedures with no intraoperative complications.
- Hybrid procedures successfully treated 19 stenoses, including 3 left main stenoses.
- Postoperative courses were uneventful; no decline in renal, neurologic, or respiratory function was observed.
- Angiograms confirmed patent LIMA grafts and anastomoses in early and 12-month follow-ups.
Conclusions:
- Beating heart surgery with hybrid revascularization is safe and effective for selected patients.
- This approach is beneficial for patients with coronary artery disease, including left main stenosis.
- The technique offers advantages over conventional coronary artery bypass grafting, especially in patients with complex disease.
Background:
The outcome of patients (n = 45) with coronary one- to three-vessel disease undergoing beating heart operations using a recently developed stabilizing device was investigated.
Methods:
Left internal mammary artery-to-left anterior descending coronary artery (LIMA-to-LAD) revascularization was carried out alone (n = 31) or as hybrid procedure in combination with a balloon angioplasty (n = 14).
Results:
All 45 patients underwent a successful LIMA-to-LAD procedure without intraoperative complication during a 21 +/- 8-minute (range, 10 to 53 minutes) LAD occlusion time. In 14 hybrid procedures a total of 19 stenoses including 3 left main stenoses were treated successfully by percutaneous transluminal coronary angioplasty and stenting. The postoperative courses were uneventful with the exception of two surgical reexplorations necessitated by bleeding. No worsening of renal, neurologic, or respiratory functions occurred in any patient. In the group having a single LIMA-to-LAD procedure, early postoperative coronary angiograms (22 of 31) showed a patent LIMA graft and excellent anastomosis; this was also true in 4 patients 12 months after operation as shown in angiograms. All patients undergoing hybrid revascularization demonstrated a patent LIMA-to-LAD anastomosis; in 1 patient there was a dissection in the midlevel of the LIMA, which was stented successfully. The 6-month follow-up angiograms in 7 of 14 patients revealed open LIMA bypass grafts in all patients except 1, who was stented because of dissection.
Conclusions:
These data indicate that a beating heart operation including hybrid revascularization is safe and effective in selected patients with coronary one- to three-vessel disease including left main stenosis. This approach may be especially advantageous in comparison with conventional coronary artery bypass grafting in patients with severe concomitant disease.