"One-slop" hybrid approach for multi-vessel coronary artery disease in 35 patients / 中华胸心血管外科杂志

Objective To summarize the clinical experience of "One-stop" hybrid procedure that performs minimally in-vasive direct coronary artery bypass ( MII)CAB ) and percutaneous coronary intervention ( PC! ) concurrently on 35 patients with multivessel coronary artery disease (CAD). Methods Between June 2007 and May 2008, 35 patients [33 men and 2women, mean age (63.5±9.2) years] with multivessel CAD ( two-vessel CAD, n = 19; three-vessel CAD, n = 16, left main coronary artery disease, n = 7 ; coronary artery lesions, 2.5 lesions per patient) underwent "one-stop" hybrid procedure. The hybrid strategy was performed as a primary MIDCAB procedure for bypassing the left internal mammary artery ( LIMA ) to the left anterior descending artery ( LAD ), simultaneously followed by PCI ( pereutaneous transluminal coronary angioplasty (PTCA) and/or stenting) on the remaining non-LAD vessels. Concomitant diseases included hypertention in 20 patients, hy-perlipemia in 12 patients, previous myocardial infarction (MI) in 10 patients, diabetes mellitus (type 2) in 9 patients, previ-ous cerebrovascular disease in 2 patients, chronic obstructive pulmonary disease (COPD) in 1 patient, renal dysfunction in 1 patient, and ostium secundum atrial septal defect in 1 patient. The left ventricular ejection fraction (LVEF) averaged 0. 62±0.07. Results There were no reexploration for bleeding, strokes, myocardial infarctions, acute renal dysfunctions, or deaths in hospetal. Of the total 35 patients, 34 patients (97.1%) were successfully treated with "one-stop" hybrid procedure, and 1 patient (2.9%) was converted to conventional coronary artery bypass grafting ( CABG ) because of dissection of one obtuse marginal branch during PCI. One of the LIMA-LAD grafts was confirmed to be anastomotic stenosis by followed coronary angiog-raphy and was corrected immediately. The patient with ostium secundum defer underwent tranesophageal echocardiography guiding transcatheter closure after LIMA-LAD anastomosis. Catheter-based interventions were carried out in 61 coronary le-sions, including PTCA in 6 lesions and implantation of 62 drug-elating stents (DES) in the rest appropriate lesions. The mean number of DES implantation was 1.8 per patient, and the average diameter and length of implanted DES were respectively ( 3.2±0.5 )mm and 37.3 mm per patient. Of the 34 patients receiving hybrid procedure, the average mechanical ventrilation time was ( 10.8±7.9) hours, and 4 ( 11. 8% ) pateints were extubated in the operating room; length of stay in the intencive care unit averaged (33.6±33.0) hours and hospital stay (9±3) days; 24 patients (70.6%) avoided transfusion require-ment. Conclusion Our findings indicate that in high-risk patients with multivessel CAD, the "one-stop" hybrid procedure by performing MIDCAB and PCI simultaneously is a feasible and safe alternative.

Hybrid techniques in coronary revascularization / 中国微创外科杂志

Objective To summarize clinical results of 29 cases of multi-vessel coronary disease treated by hybrid revascularization.Methods A total of 29 consecutive patients(all male,aged 62.8?9.7 years) with coronary artery disease(two-vessel,n=10;three-vessel,n=19) were treated with minimally invasive direct coronary artery bypass(MIDCAB)(left internal mammary artery to left anterior descending artery,LIMA-to-LAD) and percutaneous coronary intervention(PCI) between January 2000 and April 2005.The left ventricular ejection fraction(LVEF) was 0.576?0.108.Concomitant diseases included hypertension in 23 patients,insulin-dependent diabetes mellitus in 5 patients,chronic obstructive pulmonary disease in 2 patients,and old myocardial infarction in 14 patients.Results The 29 patients received 33 grafts(LIMA: 27 grafts;great saphenous vein: 6 grafts).Balloon angioplasty was carried out in 41 coronary lesions,usually following surgery.The mean number of revascularization was 2.5 per patient.There was no surgery-related complications and mortality.The blood flow in the LIMA was 45?14 ml/min.The chest drainage volume was 274?197 ml.Blood transfusion was required in 2 patients(6.9%).The length of ICU stay was 1.9?0.1 d and the length of hospital stay was 4~11 d(mean,7.5 d).Follow-up for 2.2?0.9 years showed no late death and myocardial infarction.Postoperative New York Heart Association(NYHA) Classification showed Class Ⅰ in 25 patients and Class Ⅱ in 4 patients.Repeated angiography was conducted in 4 patients,which found great saphenous vein graft occluded in 1 patient and stent re-stenosis in 2 patients.Conclusions The midterm results of hybrid techniques for coronary artery disease are satisfactory.Hybrid procedure is beneficial to high-risk patients.The long-term results need further investigation.

Coronary Artery Bypass Grafting without Cardiopulmonary Bypass and Percutaneous Coronary Angioplasty in a Patient with Cerebrovascular Stenosis / 日本心臓血管外科学会雑誌

Complete revascularization of the coronary artery was performed in a 73-year-old man who had severe stenosis of the bilateral subclavian and left vertebral arteries and severe calcification of the ascending aorta. At first, we performed CABG (coronary artery bypass grafting) on the LAD (left anterior descending artery) and the RCA (right coronary artery) without cardiopulmonary bypass. <i>In-situ</i> GEA (gastroepiploic artery) was anastomosed to the LAD and SVG (saphenous vein graft) was anastomosed to 4 PD (4 posterior descending artery) of the RCA. The right brachiocephalic artery was selected as the site of the proximal anastomosis of the SVG. A Palmaz-Schatz stent was then held in place in the LCX (left circumflex artery) postoperatively. The combination of CABG without cardiopulmonary bypass and PTCA was a safe method for preventing cerebrovascular complications in a patient with a severely calcified artery.

A Case of Hybrid Revascularization in Reoperation of Coronary Artery Bypass Graft Surgery / 日本心臓血管外科学会雑誌

Hybrid revascularization by MIDCAB and stent was performed in a 70-year-old man for reperfusion in the treatment of graft stenosis after CABG. The right SVG, which supplied coronary blood flow, was immediately under the median incision site, and was approached safely by the present method. After intervention, bleeding in the left thoracic cavity occurred, but this was treated conservatively. During intervention after cardiac surgery, transient heparinization of blood was performed for prevention of coagulation. Since strong anticoagulative treatment was continued thereafter, the patient was easily bled. Therefore, it appeared preferable to take time after cardiac operation or insert an indwelling drainage tube into the pleural cavity to monitor hemorrhage. The present method appears useful for patients undergoing re-operation or of high risk.