RSS-Feed abonnieren
DOI: 10.1055/s-2000-8350
© Georg Thieme Verlag Stuttgart · New York
Follow-Up Experience with Coronary Hybrid-Revascularisation[*]
Publikationsverlauf
Publikationsdatum:
31. Dezember 2000 (online)
![](https://www.thieme-connect.de/media/thoracic/200006/lookinside/thumbnails/10.1055-s-2000-8350-1.jpg)
Background: Minimally invasive direct coronary artery bypass (MIDCAB) grafting is an accepted therapeutical option especially in multimorbid, elderly and reoperative patients with single vessel disease. To expand the benefits of MIDCAB to patients with multivessel disease, an interdisciplinary hybrid approach was recently introduced. This study cornprises follow-up information by coronary re-angiography. Methods: 35 patients (29 male, 6 female, mean age 56.7 ± 17 years) underwent a “hybrid” revascularisation using a primary MIDCAB procedure with LIMA bypass to LAD followed by staged angioplasty and stenting of additional coronary lesions. Follow-up was performed in the outpatient department at the time of control angiography. Results: After an uneventful hybrid revascularisation without procedure related complications, all patients were alive and angina-free with normal-stress ECG after 11.4 ± 7.7 months postoperatively. Control angiography (n = 14) revealed a patency rate of 100 % (LIMA bypasses) and 93.3 % (PTCA), respectively. Conclusions: The “hybrid” approach to myocardial revascularisation is safe and effective for complete revascularisation in selected patients with multivessel involvement. Especially elderly and reoperative patients with significant comorbidity may benefit from hybrid procedures avoiding cardiopulmonary bypass and midsternotomy.
Key words:
Hybrid Revascularisation - MIDCAB Grafting
1 Manuscript is presented at the 3rd Joint Meeting of the German, the Austrian and the Swiss Societies for Thoracic and Cardiovascular Surgery, Luzern, February 9 - 12, 2000
References
- 1 Cameron A, Cavis K B, Green G. et al . Coronary bypass surgery with internal-thoracic-artery grafts - effects on survival over a 15-year-period. N Engl J Med. 1996; 334 216-219
- 2 Boylan M J, Lytle B W, Loop F D. Surgical treatment of isolated left anterior descending coronary stenosis: comparison of left internal mammary artery and venous autograft at 18 to 20 years' follow up. J Thorac Cardiovasc Surg. 1994; 107 657-662
- 3 Deng M C, Wiedner M, Erren M. et al . Arterial and venous cytokine response to cardiopulmonary bypass for low risk CABG and relation to hemodynamics. Eur J Cardiothorac Surg. 1995; 9 22-29
- 4 Cremer J, Martin M, Redl H. Systemic inflammatory response syndrome after cardiac operations. Ann Thorac Surg. 1996; 61 1714-1720
- 5 Kirklin J K, Westaby S, Blackstone E H. Complement and the damaging effects of cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1983; 86 845-857
- 6 Benetti F J, Naselli G, Wood M. et al . Direct myocardial revascularization without extracorporeal circulation. Experience in 700 patients. Chest. 1991; 100 312-316
- 7 Buffollo E, Silva de Andrade J C, Rodrigues Branco J N. Coronary artery bypass surgery without cardiopulmonary bypass. Ann Thorac Surg. 1996; 61 63-66
- 8 Pfister A J, Zaki M S, Garcia J M. Coronary artery bypass without cardiopulmonary bypass. Ann Thorac Surg. 1992; 54 1085-1092
- 9 Calafiore A M, DiGiammarco G, Teodori G. et al . Midterm results after minimally invasive coronary surgery (LAST operation). J Thorac Cardiovasc Surc. 1998; 115 763-771
- 10 Cremer J, Strueber M, Wittwer T. et al .Off-Bypass Grafting via Minithoracotomy Using Mechanical Epicardial Stabilization. Ann Thorac Surg 1997 63: 79-83
- 11 Zenati M, Cohen H A, Griffith B P. Alternative approach to multivessel coronary Disease with integrated coronary revascularization. J Thorac Cardiovasc Surg. 1999; 3 439-446
- 12 Wittwer T, Cremer C, Boonstra P, Grandjean J, Mariani M, Muegge A. et al . Myocardial “hybrid” revascularisation with minimally invasive direct coronary artery bypass grafting (MIDCAB) combined with coronary angioplasty: Preliminary results of a multicenter study. Heart. 2000; 83 58-63
- 13 Ryan T J, Faxon D P, Gunnar R M. et al . Guidelines for Percutaneous Transluminal Coronary Angioplasty. Circulation. 1988; 78 486-502
- 14 O'Keefe J H, Rutherford E D, McConahay D R. Multivessel coronary angioplasty from 1980 to 1989: procedural results and long-term outcome. J Am Coll Cardiol. 1990; 16 1097-1102
- 15 Bourassa M G, Holubkov R, Yeh W. et al . Strategy of complete revascularization in patients with multivessel coronary artery Disease (a report from the 1985 - 1986 NHLBI PTCA registry). Am J Cardiol. 1992; 70 174-178
- 16 Haverich A, Cremer J. Perspectives of operative myocardial revascularization - minimally invasive coronary bypass - an alternative?. Z Kardiol. 1998; 87 ((Suppl 2)) 175-180
- 17 Mariani M A, Boonstra P W, Grandjean J G, Peels J O J, Monnink S H J, Hejier P D. et al . Minimally invasive coronary artery bypass grafting versus coronary angioplasty for isolated type C stenosis of the left anterior descending artery. J Thorac Caraiovasc Surg. 1997; 114 434-439
- 18 Landau C, Lange R, Hillis D. Percutaneous transluminal coronary angioplasty. N Engl J Med. 1994; 330 981-993
- 19 Leimgruber P P, Roubin G S, Hollman J. et al . Restenosis after sucessful coronary angioplasty in patients with single vessel disease. Circulation. 1986; 73 710-717
- 20 Weintraub W S, Kosinski A S, Brown C L. et al . Can restenosis after angioplasty be predicted from clinical variables?. J Am Coll Cardiol. 1993; 21 6-14
- 21 Hirshfeld J W, Schwartz J S, Jugo R. et al . Restenosis after Coronary Angioplasty: A Multivariate Statistical Model to Relate Lesion and Procedure Variables to Restenosis. J Am Coll Cardiol. 1991; 18 647-656
- 22 Versaci F, Gaspardone A, Tomai F. et al . A comparison of coronary artery stenting with angioplasty for isolated stenosis of the proximal left anterior descending coronary artery. N Engl J Med. 1997; 336 817-822
- 23 Angelini G D, Wilde P, Salerno T A. et al . Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularization. Lancet. 1996; 347 757-758
- 24 Friedrich G J, Bonatti J, Dapunt O E. Preliminary experience with minimally invasive coronary-artery bypass surgery combined with coronary angioplasty. N Eng J Med. 1997; 336 1454-1455
- 25 Liekwig W G, Misra R. Minimally invasive coronary artery bypass, percutaneous transluminal coronary angioplasty and stent placement for left main stenosis. J Thorac Cardiovasc Surg. 1997; 113 411-412
1 Manuscript is presented at the 3rd Joint Meeting of the German, the Austrian and the Swiss Societies for Thoracic and Cardiovascular Surgery, Luzern, February 9 - 12, 2000
M.D. Thorsten Wittwer
Department of Cardiothoracic and Vascular Surgery Friedrich-Schiller University
07740 Jena
Germany
Telefon: +49-3641-934801
Fax: +49-3641-934802
eMail: Th.Wittwer-MD@t-online.de