Hybrid revascularisation in multivessel coronary artery disease

Reviewer

Bartosz Rylski

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My Comment

Background

Minimally invasive hybrid revascularization (MIHR) by means of the left mammary artery on the left anterior descending artery (minimally invasive direct coronary artery bypass – MIDCAB) combined with percutaneous coronary interventions (PCI) is an alternative to conventional coronary artery bypass grafting or multiple PCI.

Major findings

• 166 patients underwent MIHR at a single institution

• 4 patients were conversed to sternotomy due to adhesions

• 106 underwent PCI prior to MIDCAB and remaining 60 after MIDCAB

• There were no intraoperative complications and no mortality

• In-hospital mortality was 1.2% (2/166)

• Complete revascularisation was achieved in all patients

•  During the mean follow-up of 4.5 ± 2.3 years 5 patients died of cardiac and 3 of non-cardiac causes. In those with follow-up angiography (n=20) 100% patency rate of LIMA-LAD graft was observed

My comments

The authors presented excellent perioperative and long-term results for MIHR – hybrid coronary revascularisation, which combines the most proven efficacious treatment of cardiac surgeons and interventional cardiologist, that is minimally-invasive coronary artery bypass on LAD and PCI for non-LAD lesions. This promising strategy integrates all the advantages of both techniques and is currently applied usually in high-risk patients. Reported revascularisation strategy shows again that close cooperation between cardiac surgeons and interventional cardiologists is mandatory to achieve the best results in coronary artery disease treatment.