The integrated "hybrid" approach to revascularisation in multivessel coronary artery disease: Combining minimally invasive coronary bypass and angioplasty

R. Mehran, J. M. Ahmed, G. Dangas, M. K. Hong, P. Corso, A. Pfister, M. Dullum, K. Kent, A. D. Pichard, L. F. Satler, G. S. Mintz, A. Abizaid, A. J. Lansky, G. W. Stone, M. B. Leon

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Coronary artery bypass graft surgery is indicated for multivessel coronary artery disease (MVD). However peri-operative complications related to the cardiopulmonary bypass (CPB) and the advantages of in-situ arterial conduits compared to saphenous vein grafts has directed the development of minimally invasive direct coronary artery bypass (e), a new technique in which the left internal mammary artery (LIMA) is anastomosed to the left anterior descending (LAD) under visualisation via mini lateral thoracotomy without CPB. Limitations of current MIDCAB procedure in MVD patients may be overcome by combining (in a staged fashion) surgery with angioplasty, i.e. the "hybrid approach". We studied the clinical outcome of the patients who underwent percutaneous revascularisation in association with MIDCAB. Of the 212 consecutive patients treated by MIDCAB -LAD, 31(14.6%) had angioplasty of non -LAD lesions (the hybrid cohort); 78% male, mean age 61±11 years, 39% diabetics). Angioplasty was performed on 58 lesions, predominantly using stents (86%). Twenty seven patients (87%) had angiography of LIMA at the time of angioplasty (3.6±2.1 days. At follow-up (6.5±1.2 months), there was no death or MI, and only four non-LAD lesions (all angioplasty sites) required revascularisation (6.9%). Conclusion: In patients with MVD and appropriate anatomy, the integrated ±hybrid± approach (1) is safe with rare periprocedural complications and high early LIMA patency ; (2) provides favorable 6- month clinical outcomes, while avoiding the morbidity of CPB and late saphenous vein graft conduit disease. These initial results support the need for a prospective trial of MVD patients, with randomisation into the hybrid vs conventional surgery on CPB approach vs. multivessel stenting.

Original languageEnglish
Pages (from-to)P50
JournalHeart
Volume81
Issue numberSUPPL. 1
StatePublished - May 1999
Externally publishedYes

Fingerprint

Dive into the research topics of 'The integrated "hybrid" approach to revascularisation in multivessel coronary artery disease: Combining minimally invasive coronary bypass and angioplasty'. Together they form a unique fingerprint.

Cite this