Routine Intraoperative Completion Angiography After Coronary Artery Bypass Grafting and 1-Stop Hybrid Revascularization (original) (raw)
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Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up
Annals of Thoracic Surgery, 2002
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.
Hybrid coronary revascularization in high-risk patients
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital
From January 2002 through June 2004, 17 patients (2% of all coronary cases) were treated with off-pump coronary artery bypass grafting combined with percutaneous coronary intervention. There were 13 men and 4 women, whose ages ranged from 54 to 78 years (mean, 63.1 +/- 20.9 yr). Preoperative angiography revealed 2-vessel coronary artery disease in 12 patients and 3-vessel disease in the remaining 5 patients. In all patients, extensive lesions (>50%) in the circumflex and right coronary arteries were treated first with a percutaneous intervention, followed by beating-heart coronary artery bypass grafting within 3 hours to treat the remaining obstructed vessels. Coronary angiography was performed 12 months after the operation to evaluate the effectiveness of the procedure. Procedure-related complications did not occur, and there was no in-hospital death. All patients underwent a successful left internal mammary artery-left anterior descending artery anastomosis with the exception o...
A Practical Approach to Hybrid Coronary Revascularization
Cardiology in Review, 2020
Combined surgical and percutaneous coronary revascularization, ie, hybrid coronary revascularization (HCR) consists of surgical left internal mammary artery (LIMA) bypass to the left anterior descending artery (LAD) and percutaneous revascularization of other diseased coronary arteries. Developed as a 1-stage procedure, HCR has not been widely adopted by the cardiovascular community. The recommended minimally invasive approach through a small left thoracotomy incision is technically demanding, and same-day percutaneous revascularization requires a hybrid operating room that is not available in most hospitals. In this review, we consider present HCR protocols, barriers to widespread adoption of HCR, and we give special attention to the surgical approach for the LIMA graft to the LAD and the timing of percutaneous revascularization. We conclude that grafting the LIMA to the LAD through a median sternotomy approach and delaying the percutaneous revascularization may facilitate the widespread use of HCR in patients with multivessel coronary artery disease and a low to intermediate Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score.
2013
The "hybrid" approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions. Ideally, the LITA to LAD bypass graft is performed in a minimally invasive fashion. This review aims to clarify the place of hybrid coronary revascularization (HCR) in the current therapeutic armamentarium against multivessel coronary artery disease. Eighteen studies including 970 patients were included for analysis. The postoperative LITA patency varied between 93.0% and 100.0%. The mean overall survival rate in hybrid treated patients was 98.1%. Hybrid treated patients showed statistically significant shorter hospital length of stay (LOS), intensive care unit (ICU) LOS, and intubation time, less packed red blood cell (PRBC) transfusion requirements, and lower in-hospital major adverse cardiac and cerebrovascular event (MACCE) rates compared with patients treated by on-pump and off-pump coronary artery bypass grafting (CABG). This resulted in a significant reduction in costs for hybrid treated patients in the postoperative period. In studies completed to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of multivessel coronary artery disease in a selected patient population.
Single-stage hybrid coronary revascularization with long-term follow-up†
European Journal of Cardio-Thoracic Surgery, 2013
OBJECTIVES: Hybrid coronary revascularization, performing a left internal thoracic artery (LITA) to left anterior descending (LAD) bypass followed by percutaneous coronary intervention (PCI) in a non-LAD coronary artery lesion, represents an evolving revascularization strategy. It utilizes the survival benefit of the LITA-to-LAD bypass, while providing complete revascularization with PCI to a non-critical vessel to decrease procedural morbidity. However, quantitative patency results and clinical outcomes remain understudied. The objective of this study was to assess clinical follow-up and graft and stent patency at 6 months and 5 years in a single-stage hybrid revascularization population. METHODS: From 2004 to 2012, a total of 96 patients (64 ± 12 years; 70 males and 26 females) consented to robotic-assisted LITA harvesting and a small left anterior thoracotomy for off-pump coronary artery bypass anastomosis onto the LAD. This was followed immediately by PCI in a non-LAD vessel in the same fluoroscopy-equipped hybrid operating room. Patients underwent a yearly clinical follow-up and a protocol-directed assessment of graft patency via a coronary angiogram at 6 months and cardiac computed tomography (CT) angiography with single-photon emission computed tomography myocardial perfusion scintigraphy (MPS) at 5 years. RESULTS: Successful single-stage hybrid revascularization occurred in 94 of the 96 patients (2 patients required intraoperative conversion to conventional coronary bypass). Six-month protocol coronary angiogram follow-up has been performed in 85 patients. Fitzgibbon Grade A or B LITA-to-LAD patency at 6-month follow-up was 94% in those studied. A total of 105 stents were deployed (89 drug-eluting stents (DES) and 16 bare metal), and at 6-month follow-up in 85 patients, 79 stents were widely patent; 8 had in-stent restenosis, and 2 were completely occluded. To date, 19 patients have undergone 5-year coronary CT angiography and MPS. The LITA-to-LAD anastomosis was patent in 17 of the 19 patients. Of the 19 lesions in which PCI was performed, 17 were widely patent, while 2 circumflex DES were occluded. Fiveyear clinical outcome demonstrated 91% survival, 94% freedom from angina and 87% freedom from any form of coronary revascularization. CONCLUSIONS: A single-stage hybrid revascularization strategy appears to have acceptable 6-month and angiographic patency results for both LITA-LAD grafts and PCI interventions. Survival, freedom from angina and freedom from revascularization also appear favourable at the 5-year clinical follow-up.
Role and Rationale for Hybrid Coronary Artery Revascularization
Coronary Artery Disease - Assessment, Surgery, Prevention, 2015
The optimal revascularization strategy for patients with multi-vessel coronary artery disease remains controversial. The advent of percutaneous coronary intervention (PCI) has challenged the superiority of coronary artery bypass graft (CABG) surgery for multi-vessel disease. In the late 1990s, an integrated approach, now referred to as "hybrid coronary revascularization" (HCR), was pioneered combining CABG and PCI to offer appropriate patients a less invasive option for revascularization while still capitalizing on the superior patency rates of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery bypass. The operative techniques continue to evolve as well as the timing strategies for intervention and use of antiplatelet therapy. While more research is needed, current data supports hybrid coronary revascularization as a promising technique to optimize outcomes in patients with multi-vessel coronary artery disease.
Hybrid coronary revascularization: present indications and future perspective
Current treatment options in cardiovascular medicine, 2015
Hybrid coronary revascularization (HCR) strategy consists of minimal invasive left internal mammary artery to left anterior descending bypass grafting and percutaneous coronary intervention (PCI) of the remaining lesions. HCR combines the known benefits of the LIMA-to-LAD graft (LIMA: left internal mammary artery, LAD: left anterior descending) and drug eluting stent (DES) to non-LAD regions and is currently reserved for particularly high-risk patients with favorable anatomy. Despite the lack of multicenter randomized trials, several small non-randomized studies have shown that HCR is safe with low mortality rates, low morbidity, and shorter intensive care unit and hospital stay. Up to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of multivessel coronary artery disease in a selected patient population.
Hybrid Coronary Revascularization
Journal of the American College of Cardiology, 2015
Hybrid coronary revascularization (HCR) combines arterial coronary artery bypass surgery (most commonly minimally invasive) and percutaneous coronary intervention in the treatment of a particular subset of multivessel coronary artery disease. It was first introduced in the mid-1990s, and aspired to bring together the "best of both worlds": the excellent patency rates and survival benefits associated with the durable left internal mammary artery graft to the left anterior descending artery alongside the good patency rates of drug-eluting stents, which outlive saphenous vein grafts to non-left anterior descending vessels. Although in theory this is a very attractive revascularization strategy, several years later, only one small randomized controlled trial comparing HCR with coronary artery bypass grafting has recently emerged in the medical literature, raising concerns regarding HCR's role and generalizability. In the current review, we discuss HCR's rationale, the current evidence behind it, its limitations and procedural challenges.
Hybrid coronary artery revascularization: initial experience of a single centre
European Heart Journal Supplements, 2015
Current guidelines recommend coronary bypass grafting (CABG) as the treatment of choice for patients with triple vessel and left main disease, although the growing use of drug-eluting stents (DES) has significantly reduced the rate of restenosis and extended the use of percutaneous coronary interventions (PCIs). Hybrid coronary revascularization (HCR) integrates the positive features of both PCI and CABG. We present preliminary results of a prospective study designed to verify the selection of candidates for treatment with hybrid approach. Between September 2011 and August 2014, 42 patients [(M ¼ 37 (88.1%); mean age 68.6 + 10.3 years, range 53-90] were selected to receive a complete (all lesions of main vessels treated) coronary revascularization with a hybrid approach at our Institution. Age-creatinine-ejection-fraction score was high (.1.277) in 16 (38%) patients, median 1.2 (0.77; 2.89). All patients underwent off-pump single-vessel revascularization (left internal thoracic artery to the left anterior descending coronary artery) using a left-anterior small thoracotomy and percutaneous coronary angioplasty. Eighteen patients (42.8%) underwent a simultaneous hybrid approach. Drug-eluting stents were used to treat 49 lesions, were also implanted 6 (7.6%) bioabsorbable stents. Procedural success was obtained in 41 (97.6%) patients. No conversion to full sternotomy and no blood transfusions were necessary during surgery. Median ventilation time was 7.7 (3-33) h and median hospital length of stay was 6 days (3-14). All patients were alive at discharge. Our early experience with HCR shows encouraging results. Randomized studies on a larger series with a longer follow-up are required.