Hybrid revascularisation in multivessel coronary artery disease

Selected in European Journal of Cardio-Thoracic Surgery by Rylski

References

Authors

Alberto Repossini, Maurizio Tespili, Antonio Saino, Igor Kotelnikov, Annalisa Moggi, Lorenzo Di Bacco, Claudio Muneretto

Reference

Eur J Cardiothorac Surg (2013) 44 (2): 288-294

Published

July 2013

Link

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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.

1 comment

  • NK Aboobacker 26 Aug 2013

    CABG is gold standard in revascularisation , but MIDCAB will be a palatable option , less messy for both patients and surgeons. The data is most encouraging and seems a game changer for cooperations between Physicians and surgeons. DR Aboo