Single-stage hybrid coronary revascularization with long-term follow-up
Selected in European Jounal of Cardio-Thoracic Surgery by Rylski
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
Eur J Cardiothorac Surg (2014) 45 (3): 438-443
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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.
- 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
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.