Hybrid approach to multi-vessel disease shows promise

Recent publications describing the excellent long-term results of minimally invasive coronary artery bypass grafting using the left internal mammary artery (LIMA) to supply the left anterior descending coronary artery (LAD) [ATS 2007;83:108-14], have raised interest for hybrid revascularisation procedures which involve minimally invasive CABG to LAD and stenting (PCI) of remaining lesions in coronary arteries other than the LAD.

Holzhey et al. reported the short- and long-term results of 117 patients who received a minimally invasive hybrid approach. Revascularisation of the LAD was performed by either minimally invasive direct coronary artery bypass grafting (MIDCAB; 107 patients), beating-heart total endoscopic coronary artery bypass grafting (TECAB; 8 patients) or arrested-heart TECAB (2 patients). PCI was performed on other vessels 4 to 6 weeks preoperatively (53 patients), intraoperatively (5 patients) or between 2 to 45 days postoperatively (59 patients).

Kaplan-Meier survival was 92.5% (95% CI: 86.5% to 98.4%) at 1 year and 84.8% (95% CI: 73.5% to 94.9%) at 5 years. Event-free survival was 85.5% (95% CI: 76.9%  to 94.1%) at 1 year and 75.5% (95% CI: 62.7% to 87.3%) at 5 years.

The authors conclude that a minimally invasive hybrid approach offers a safe and acceptable strategy in centres where the necessary expertise is available and may have particular applicability to patients deemed high-risk for conventional sternotomy. A larger scale, randomised, clinical trial is necessary to investigate these findings further.

  • Murphy GJ,Bryan AJ, Angelini GD.  Hybrid Coronary Revascularization in the Era of Drug-Eluting Stents. Ann Thorac Surg 2008;86:1856-60 

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