Hybrid coronary revascularization with endoscopic closed-chest arterial coronary bypass technique (endo-CABG)

Abstract

Introduction Treatment of three-vessel coronary disease in minimally invasive manner could be complex in some cases. Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) gives good patency rates which outlive vein grafts. The hybrid approach, combination of PCI with minimally invasive endoscopic coronary artery bypass graft (endo-CABG), might be a valuable option for treatment of multivessel coronary disease. Hereby we describe our series of patients undergoing arterial revascularization of the anterior and/or lateral wall combined with PCI of the right coronary artery or a marginal branch. Methods From March 2013 until December 2019, 208 patients (82.2% males, mean age: 66.69±10.44 years) underwent hybrid coronary revascularization for multivessel disease. Patients with multivessel disease suitable for hybrid approach were accepted at the heart team. All patients received total arterial revascularisation by endo-CABG. The PCI was prior or after the endo-CABG. There was no discontinuation of dual platelet therapy. Uni or bilateral internal mammary artery (IMA) harvesting was performed through three 5mm endoscopic ports in the 2nd, 3rd and 4th intercostal space. Cardiopulmonary bypass was established using a minimally invasive extracorporeal circulation (MiECC) with groin cannulation. Transthoracic aortic cross-clamping was followed by antegrade administration of a single shot cold mixed blood cardioplegia. A utility port of three centimeter was used for direct vision anastomosis. Results The procedure was successful in all patients, requiring no conversion to full sternotomy. Mean cross-clamping and cardiopulmonary bypass times were 44.38±28.33 and 91.75±37.97 minutes, respectively, with a mean of 2.1±0.91 bypasses for each patient. All patients received total arterial revascularization. The mean ICU and hospital length of stay were 62.5±39.74 hours and 8.80±4.64 days, respectively. Average postoperative blood loss over 24 hours was 555.20±859.19 mL. There were 8 re-interventions on the target vessels (3.8%) and 2 patients suffered from a stroke (1%). The 30-day mortality rate was 0.5%. Conclusion Minimally invasive hybrid arterial coronary revascularization is a safe and valuable alternative to coronary artery bypass grafting in many patients with multivessel coronary artery disease. The endo-CABG is a safe and feasible technique without compromising operative morbidity and providing good postoperative results. Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Jessa Hospital