Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up

Hybrid Coronary Revascularization as a Safe, Feasible, and Viable Alternative to Conventional Coronary Artery Bypass Grafting: What Is the Current Evidence?

“…The classical indication for an HCR procedure is multivessel coronary artery disease involving LAD lesion judged suitable for minimally invasive LITA to LAD bypass grafting but unsuitable for PCI (type C), and (a) non-LAD lesion(s) (most of the time right coronary artery (RCA) and/or circumflex coronary artery (Cx) lesions) amenable to PCI (type A or B) [7, 11, 12, 14, 17, 18, 20, 22, 23, 26–28]. High-risk patients especially with severe concomitant diseases (e.g., diabetes mellitus, malignancies, significant carotid disease, severely impaired LV function, and neurological diseases), who are more prone to develop complications after cardiopulmonary bypass and sternotomy, might benefit from the circumvention of CPB and sternotomy [11, 18, 20, 22–24].…”

“…High-risk patients especially with severe concomitant diseases (e.g., diabetes mellitus, malignancies, significant carotid disease, severely impaired LV function, and neurological diseases), who are more prone to develop complications after cardiopulmonary bypass and sternotomy, might benefit from the circumvention of CPB and sternotomy [11, 18, 20, 22–24]. …”

“…Therefore, HCR procedures are contraindicated in patients with a compromised pulmonary function (i.e., forced expiratory volume in one second less than 50% of predicted) and a small intrathoracic cavity space [14, 27, 28]. Moreover, patients with a nongraftable or a buried intramyocardial LAD, history of left subclavian artery and/or LITA stenosis, morbid obesity (BMI > 40 kg/m 2 ), and previous left chest surgery are not well suited for minimally invasive LITA tot LAD bypass grafting [14, 20, 22, 27, 28]. Conditions rendering PCI unsuitable include peripheral vascular disease precluding vascular access, coronary vessel diameter smaller than 1.5 mm, tortuous calcified coronary vessels, fresh thrombotic lesions, chronic totally occluded coronary arteries, extensive coronary involvement, chronic renal insufficiency (serum creatinine ≥ 200  μ mol/L), and allergy to radiographic contrast [7, 14, 18, 20, 22, 27, 28].…”

“…Moreover, patients with a nongraftable or a buried intramyocardial LAD, history of left subclavian artery and/or LITA stenosis, morbid obesity (BMI > 40 kg/m 2 ), and previous left chest surgery are not well suited for minimally invasive LITA tot LAD bypass grafting [14, 20, 22, 27, 28]. Conditions rendering PCI unsuitable include peripheral vascular disease precluding vascular access, coronary vessel diameter smaller than 1.5 mm, tortuous calcified coronary vessels, fresh thrombotic lesions, chronic totally occluded coronary arteries, extensive coronary involvement, chronic renal insufficiency (serum creatinine ≥ 200  μ mol/L), and allergy to radiographic contrast [7, 14, 18, 20, 22, 27, 28]. Finally, haemodynamic instability, need for a concomitant operation (e.g., valve repair or replacement), and decompensated congestive heart failure are regarded as exclusion criteria [7, 17, 20, 22, 27, 28].…”

“…Second, it is possible for the interventional cardiologist to fall back on conventional CABG in case of a suboptimal PCI result or major PCI complications. However, failure of PCI leading to emergency conventional CABG has become extremely rare with decreasing incidence since the introduction of coronary artery stenting [12, 20, 29–32]. Furthermore, this strategy allows HCR in patients with the immediate need for PCI in a non-LAD target and no immediate possibility for emergency bypass surgery [11, 24].…”