Single-stage hybrid coronary revascularization with long-term follow-up

Selected in European Jounal of Cardio-Thoracic Surgery by Rylski

References

Authors

Corey Adams, Daniel J.P. Burns, Michael W.A. Chu, Philip M. Jones, Kumar Shridar, Patrick Teefy, William J. Kostuk, Wojciech B. Dobkowski, Jonathan Romsa, and Bob Kiaii

Reference

Eur J Cardiothorac Surg (2014) 45 (3): 438-443

Published

Mars 2014

Link

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My Comment

Background

Hybrid coronary revascularization with 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 is one of current revascularisation options. This method provides survival benefit of the LITA-LAD bypass and decreased procedural mortality due to complete revascularisation with PCI. 

Major findings

  • Ninety-four of 96 patients (64 ± 12 years) underwent successful robotic-assisted LITA harvesting and a small left anterior thoracotomy for off-pump LITA-LAD bypass anastomosis followed by immediate PCI in a non-LAD vessel in a hybrid single-stage fashion.
  • There was no 30-day or in-hospital mortality, one postoperative myocardial infarction, one postoperative stroke and 4 re-thoracotomy for bleeding.
  • At 6 months follow-up, 94% LITA-LAD bypasses and 75% of all implanted stents were patent.
  • Overall survival at 5 years was 91% with 94% freedom from angina and 87% freedom from any form of coronary revascularisation

My comments

The authors provide evidence on safety and efficacy of a single-stage robotic-assisted hybrid coronary revascularisation in multivessel coronary artery disease. Whereas most of studies on this topic are designed in a staged fashion, Adams et al. report on a single stage procedure including surgical LIMA-LAD anastomosis followed by immediate PCI. The results are excellent, however long-term follow-up is still not complete. Hybrid coronary revascularisation is a task for the true Heart Team requiring close cooperation of interventional cardiologist and cardiac surgeons before, during and after the procedure. Combining the expertise of both disciplines seems to be a key to the best results of coronary revascularisation.

3 comments

  • yalda kiani 10 Mar 2014

    Hi.It seems this strategy will become the best option for complete revascularization in mutivessel CAD in the future.but more trialas are required.

  • Bartosz Rylski 11 Mar 2014

    I absolutely agree. We need more trials similar to the one from Poland (HYBRID), that Pawel mentioned. Heart team is already established for TAVI procedures, similar heart team for myocardial revascularisation might improve greatly the outcome in those patients.

  • Pawel Krzywicki 05 Mar 2014

    Some say that to keep a saphenous graft open (for a long time) one ought to leave it in the leg. Long term results are surely needed, but this and, for instance, Polish HYBRID study show that this is the way ahead.