Author + information
- Michael E. Halkos,
- John D. Puskas,
- John S. Douglas,
- Thomas Vassiliades,
- Chandan Devireddy,
- Aloke Finn,
- Robert A. Guyton and
- Henry Liberman
With hybrid coronary revascularization (HCR), minimally–invasive CABG with left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) grafting is combined with percutaneous coronary intervention (PCI) of non–LAD vessels. The purpose of this study was to examine the short–term clinical and angiographic results in one of the largest HCR series to date.
From 2003–2012, 300 consecutive patients (age=64±12, females 31%, number of diseased vessels=3.4±0.6, STS predicted risk of mortality 1.6±2.1%), underwent HCR procedures on an intent–to–treat basis at a single institution. After robotic or thoracoscopic LIMA harvest and pericardiotomy, off–pump, LIMA–LAD grafting was performed via a 3–4 cm sternal–sparing, non–rib–spreading thoracotomy. PCI was utilized to treat non–LAD lesions either before, after, or concomitant with the surgical procedure.
Of the 300 patients undergoing planned HCR, 10 (3.3%) underwent conversion to sternotomy for multivessel CABG. In the remaining 290 patients, HCR was performed with surgery first in 228 (78.6%), PCI first in 43 (14.8%) and as a concomitant procedure in 19 (6.6%). For all 300 patients, 30–day mortality, stroke, and non–fatal myocardial infarction occurred in 4 (1.3%), 1 (0.3%), and 6 (2.0%) patients, respectively. Angiographic LIMA evaluation was obtained in 265 patients which revealed a FitzGibbon A LIMA–LAD patency rate of 97.0% (257/265 patients). Repeat revascularization was required in 10 (3.3%) patients. For the 8 patients with FitzGibbon B or O LIMA–LAD patency, 7 underwent PCI and 1 underwent redo–CABG. In 2 patients, non–fatal stent thrombosis occurred after PCI which was treated with PCI.
Hybrid coronary revascularization represents an alternative approach for patients with multivessel coronary disease with excellent short–term angiographic and clinical outcomes. HCR provides a minimally–invasive alternative to traditional CABG and may provide a more durable alternative to multivessel PCI.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Multivessel Disease
Abstract Category: 45. TCT@ACC–i2: Coronary Intervention, Multivessel disease
Presentation Number: 2104M–254
- 2013 American College of Cardiology Foundation