ABSTRACT
@#Hybrid coronary revascularization (HCR) combines the advantages of minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous coronary intervention (PCI), and avoids its relative shortcomings, which has received particular attention in recent years. HCR seems to have become the third revascularization strategy for multi-vessel disease in coronary heart diseases. However, the clinical researches on HCR are still limited. This article will systematically review the comparison of HCR with coronary artery bypass grafting (CABG) and PCI, the results of HCR in specific patients, and the clinical results of different HCR strategies.
ABSTRACT
Objective To evaluate the feasibility of selecting the hybrid operation strategy according to the preoperative SYNTAX Ⅱ score by analyzing the characteristics of the SYNTAX score and the changes of the SYNTAX Ⅱ score in the different stages of the hybrid coronary artery bypass surgery. Methods Patients admitted in our hospital from Jan 1, 2016 to December 31, 2017 who received staged hybrid coronary revascularization (first stage CABG, followed by second stage PCI) were reviewed. The total SYNTAX Ⅱ scores before and after minimally invasive direct coronary artery bypass grafting (MIDCAB) were compared. Results A total of 50 patients were analyzed and scored by coronary angiography with lumen stenosis exceeding 50％. The SYNTAX Ⅰ score before MIDCAB was 36.00 points (13.00, 70.50) and the ratio of SYNTAX Ⅰ score>33 points was 58％ (29/50). After MIDCAB operation, the residual SYNTAX Ⅰ score was 11.50 points (7.00, 18.50), which decreased by 25.50 points (19.00, 33.75). According to the SYNTAX Ⅱ score before MIDCAB, a proportion of 10％ (5/50) patients who received PCI procedure showed a lower 4-year mortality than the CABG operation. The forecasted proportion SYNTAX Ⅱ score after MIDCAB increased to 38％ (19/50) while the actual proportion after MIDCAB was 42％ (21/50). The consistency between the forecasted value and the actual value was 90％ (45/50, P=0.125, McNemar test). Conclusions Using SYNTAX Ⅱ score to predict PCI or CABG treatment after MIDCAB is feasiable. The changes in SYNTAX Ⅱ score before and after MIDCAB was mainly resulted from the improvement in creatinine level after operation.
ABSTRACT
Minimally invasive direct coronary artery bypass grafting (MIDCAB) has been performed in some institutions and mid-term results have been reported. However, because of its technical difficulty, the procedure has not been gaining acceptance among cardiovascular surgeons. We report the clinical results of our MIDCAB series and describe the effect and role of the MIDCAB in the therapy of ischemic heart disease. From May 1999 through May 2002, 65 patients (age 29 to 90 years) underwent MIDCAB via a small left thoracotomy. Postoperative angiography was performed before discharge in all patients. No conversions to sternotomy were necessary. There were no operative, hospital or mid-term mortalities, nor were these any major complications, including myocardial infarction, stroke, respiratory failure, and other organ failure. Wound infection occurred in 1 patient. No graft occlusion was seen. Graft stenosis was seen in only 1 patient. The graft patency rate was 98.5% (66/67). Postoperative cardiac events included 2 incidents of angina, and 4 of atrial fibrillation. There were no incidents of congestive heart failure. MIDCAB is a safe and less-invasive operation. According to our clinical results, MIDCAB is an alternative to conventional coronary artery bypass grafting for selected patients, especially for those at high risk.
ABSTRACT
Objective To discuss the feasibility and safety of minimally invasive direct coronary artery bypass grafting (MIDCABG). Methods A total of 33 patients underwent small incision, off-pump, single-vessel direct coronary artery bypass grafting in this hospital from March 2001 to September 2003. Left anterior small thoracotomy was adopted in 14 patients, whereas partial midline sternotomy was conducted in 19 patients. The left internal mammary artery was anastomosed to the anterior descending artery in 31 patients, construction of the aorta root-anterior descending artery anastomosis using the great saphenous vein was carried out in 1 patient, and the right gastroepiploic artery was anastomosed to the posterior descending artery in 1 patient. Results The operative mortality was a zero. The intraoperative blood loss was 163?120 ml, and the postoperative drainage, 193?169 ml. The assisted respiration time after operation was 6 4?5 5 hours and the duration in ICU was 17 8?4 4 hours. Follow-up for 14 7?7 4 months found no deaths. Conclusions MIDCABG is a safe and reliable procedure, offering minimal invasion, less blood loss and fewer complications.