Hybrid coronary revascularization for the treatment of multivessel coronary artery disease

Abstract

Coronary artery disease (CAD) has typically been treated either medically, with percutaneous coronary intervention (PCI), or with coronary artery bypass grafting (CABG). As advances in stent technology and minimally invasive surgery have developed, a third option has emerged: hybrid coronary revascularization (HCR). In HCR, minimally invasive CABG and PCI are both employed to treat a single patient, often during the same hospital stay. Patients appropriate for this technique vary widely, from low-risk patients with low SYNTAX lesions outside the left anterior descending artery (LAD), to high-risk patients with multiple comorbidities who are felt by the heart team to benefit most by avoiding a sternotomy. Across both our experience and other series in the literature, mortality with HCR is around 1%. Hospital length of stay is less than one week, and typically less than after conventional CABG, but longer than with isolated PCI. Return to baseline activity is substantially shorter after minimally invasive CABG compared to conventional CABG due to the avoidance of a sternotomy; deep sternal wound infections are entirely avoided. Mid-term need for repeat revascularization may be higher with HCR, though randomized data are lacking. In conclusion, HCR is an evolving method to treat multivessel CAD with favorable early results in high volume centers, though growth in the field is limited by surgical experience and success with minimally invasive techniques.

Inverted U-shaped relationship between body mass index and multivessel lesions in Chinese patients with myocardial infarction: a cross-sectional study

“…The detailed process of defining multivessel coronary artery disease was as follows: more than two coronary arteries (anterior descending artery, circumflex artery, and right coronary artery or its branches) had > 50% stenosis and/or left main artery lesions in coronary angiography. 22 , 23 The degree of stenosis of the coronary artery was diagnosed by angiography. 24 , 25 …”

“…The detailed process of defining multivessel coronary artery disease was as follows: more than two coronary arteries (anterior descending artery, circumflex artery, and right coronary artery or its branches) had > 50% stenosis and/or left main artery lesions in coronary angiography. 22,23 The degree of stenosis of the coronary artery was diagnosed by angiography. 24,25 In this study, the following covariates were included: (1) demographic data, (2) variables affecting BMI or multivessel coronary artery disease reported by previous studies, 16,26,27 and (3) clinical experiencebased data.…”

Does percutaneous transluminal coronary angioplasty (PTCA) have comparable long-term outcomes compared to coronary artery bypass grafting (CABG) in diabetic patients?

“…68 In HCR, CABG is performed in the left anterior descending artery while PTCA is utilised to open up the other occluded vessels. 69,70 This minimally invasive CABG procedure was done using a robotic procedure where only small incisions were required rather than a midline incision. This is considered as the best of both worlds strategy where a minimally-invasive off-pump left internal mammary graft was connected to the blocked left anterior descending artery, and a stent was then placed from the left main to the left circumflex artery.…”

Respite for hybrid coronary revascularization

“…The surgical LIMA to LAD surgical anastomosis is commonly performed through an anterolateral thoracotomy at the level of the 4-5th intercostal space. The thoracotomy approach has the advantage of shorter ventilation time and post-operative length of stay over a conventional CABG sternotomy [72][73][74][75] . However, thoracotomy may be associated with increased pain levels in the immediate post-operative period [70,76] .…”