{"id":42,"date":"2009-01-17T16:31:52","date_gmt":"2009-01-17T15:31:52","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=42"},"modified":"2015-11-12T13:15:50","modified_gmt":"2015-11-12T12:15:50","slug":"hybrid-approach-to-multi-vessel-disease-shows-promise","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2009\/01\/17\/hybrid-approach-to-multi-vessel-disease-shows-promise\/","title":{"rendered":"Hybrid approach to multi-vessel disease shows promise"},"content":{"rendered":"

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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.<\/p>\n

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).<\/p>\n

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%\u00a0 to 94.1%) at 1 year and 75.5% (95% CI: 62.7% to 87.3%) at 5 years.<\/p>\n

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.<\/p>\n