冠状动脉旁路移植术后左乳内动脉-左前降支桥血管转归及影响因素分析

目的探讨冠状动脉旁路移植术(CABG)后左乳内动脉-左前降支(LIMA-LAD桥血管的转归及影响因素。方法入选2002年11月至2016年12月北京安贞医院心内科因CABG术后胸闷、胸痛症状复发接受冠状动脉造影的患者共632例。收集患者基本信息、发病相关临床信息、既往病史、实验室化验指标以及CABG时长、术前LIMA管径、峰流速等资料。根据冠状动脉造影结果评价LIMA-LAD桥血管狭窄程度,将LIMA-LAD桥血管狭窄≥50%的患者归入狭窄组(139例),LIMA-LAD桥血管狭窄50%的患者归入非狭窄组(493例)。结果 632例患者中男性518例(82.0%),平均年龄(59.78±8.70)岁;再发心绞痛582例(92.1%),急性心肌梗死50例(7.9%)。所有患者CABG距离冠状动脉造影时间为(52.14±42.77)个月。狭窄组患者外周血管疾病比例(2.9%比8.3%,P=0.025)、CABG距离造影时间[29.0(14.0,73.0)个月比42.0(18.5,79.0)个月,P=0.041]、CABG术前LIMA峰流速[64.60(54.75,80.00)cm/s比70.00(58.35,84.10)cm/s,P=0.025]均低于非狭窄组,而CABG术前LAD狭窄75%的比例(22.3%比6.7%,P0.001)显著大于非狭窄组,差异均有统计学意义。logistic回归分析结果显示,CABG术前LAD狭窄75%(OR 3.796,95%CI 2.046～7.045,P0.001)与术后LIMA-LAD桥血管狭窄存在相关性,冠心病危险因素(如高血压病、糖尿病、吸烟)以及CABG手术时长等与桥血管狭窄无明显相关性。结论 CABG术前LAD靶血管狭窄程度可能影响术后LIMA-LAD桥血管狭窄的发生,术前评估冠状动脉应考虑靶血管狭窄程度对LIMA桥血管通畅性的影响。     

左胸小切口冠状动脉旁路移植术53例临床分析

目的 总结53例经左胸小切口微创冠状动脉旁路移植术（MIDCAB）的手术疗效.方法 回顾性分析2009年7月至2012年7月我院行MIDCAB 53例,其中单纯MIDCAB 44例,MIDCAB与经皮冠状动脉介入术杂交9例.结果 全组无手术死亡,无手术并发症.1例术中转正中开胸手术.呼吸机脱机时间（3.0±3.5）h,引流量（145±60） ml,全组患者均未输血,术后住院（7.0±1.5）d.53例均进行随访,随访时间2～ 36个月,无死亡病例,心绞痛复发4例[7.7％（4/52）],术后冠状动脉造影示1例吻合口狭窄50％,余3例前降支与左乳内动脉吻合口通畅.结论 MIDCAB手术安全有效、损伤小,临床效果满意.     

左胸小切口与胸骨正中切口非体外冠状动脉旁路移植术中左乳内动脉桥血流对比分析

目的:通过超声瞬间血流仪在术中评估左胸小切口冠状动脉旁路移植术(MIDCAB)和胸骨正中切口非体外循环下冠状动脉旁路移植术(OPCAB)患者左乳内动脉(LIMA)桥的血流情况。方法:2013-01至2015-07期间300例患者接受OPCAB,LIMA全部与左前降支(LAD)吻合。70例患者采用MIDCAB,为MIDCAB组,同期有230例患者采用传统正中开胸OPCAB,为传统OPCAB组。术中应用即时血流测量技术对旁路血管进行血流测量。对比分析两组术前、术后的各项指标及LIMA桥血管的平均流量、搏动指数、舒张期充盈百分比和血流波形。结果:传统OPCAB组和MIDCAB组的手术输血量分别为(3.00±5.42)U和(1.06±2.17)U;术后心肌肌钙蛋白I(c Tn I)峰值分别是(2.84±9.93)ng/ml和(0.69±1.74)ng/ml;呼吸机使用时间分别是(27.90±66.90)h和(14.20±20.80)h;重症监护病房停留时间分别是(64.10±89.60)h和(35.20±39.20)h,两组差异均有统计学意义(P0.05)。两组的LIMA至LAD的桥血管平均流量[(29.45±18.19)ml/min vs(29.04±15.85)ml/min]、搏动指数(2.68±1.19 vs 2.44±0.84)、舒张期充盈百分比[(71.47±11.12)%vs(70.25±11.30)%]的差异均无统计学意义(P均0.05)。结论:进行LIMA至LAD搭桥,采用MIDCAB可取得与传统OPCABG同样的效果,术后早期吻合口质量可靠。     

211例冠状动脉心肌桥的血管造影特点及临床分析

目的：探讨冠状动脉造影人群中冠状动脉心肌桥的造影特点及治疗。方法：回顾性分析接受选择性冠状动脉造影1762例患者的临床资料。结果：在1762例行选择性冠状动脉造影人群中,发现心肌桥211例（12．0％）,其中202例（95．7％）发生于左前降支（LAD）,仅2例（0．9％）见于左回旋支（LCX）,7例（3．3％）见于右冠状动脉（RCA）;收缩期狭窄〈50％有79例（37．4％）,50％～75％的有106例（50．2％）,〉75％有26例（12．3％）;53例（25．1％）有典型心绞痛症状,29例（13．7％）为心肌梗死患者;所有患者均应用B受体阻滞剂或钙通道阻滞剂治疗,其中孤立性心肌桥患者140例（66．4％）患者症状明显改善;合并单支病变的35例（16．6％）,双支病变的13例（6．2％）患者,在行PCI术后给予口受体阻滞剂及钙通道阻滞剂治疗,患者症状明显改善。结论：心肌桥常见于于左前降支,部分有典型的心绞痛,无论是否对冠脉狭窄进行了PCI手术,钙离子拮抗剂及B受体阻滞剂均可缓解症状。     

心肌桥对冠脉支架内再狭窄的影响

目的 探讨心肌桥对冠脉支架内再狭窄及主要不良心脏事件发生的影响.方法 选择近3年来72例在我院因冠脉粥样硬化狭窄而行择期植入雷帕霉素洗脱冠脉支架(CypherTM)的冠心病患者,其中合并心肌桥组患者23例,无心肌桥组患者49例.两组患者术后均正规治疗并随访记录主要不良心脏事件,术后6～8个月内复查冠脉造影.结果 合并心肌桥组患者支架内再狭窄发生率为30.4%(7例),而无心肌桥组发生率为10.2%(5例),差异有统计学意义(P＜0.05);Logistic回归分析表明心肌桥是支架内再狭窄的强影响因素,其比值比是1.955,95%可信区间为1.154～3.314,P=0.0127.合并心肌桥组患者主要不良心脏事件发生率明显高于无心肌桥组患者(65.2%和18.4%,P＜0.01).结论 合并心肌桥的冠心病的患者支架内再狭窄及主要不良心脏事件发生率较高,心肌桥可增加支架内再狭窄发生率.     

有症状心肌桥患者与并存高血压及冠心病病间关系的初步探讨

目的 探讨有症状心肌桥患者的若干促发因素.方法 回顾性检索冠脉造影诊断的心肌桥患者.结果 947例次心肌桥中,累及前降支（LAD）者97.88%,最常见的伴随性心脏疾病为高血压及冠心病.这两组患者的室间隔及左室后壁厚度与正常对照组之间的差别有统计学意义（P＜0.001）.结论 促发心肌桥患者产生症状的因素为血管内血液流变学改变（冠心病时心肌桥前段动脉狭窄及桥后段血流储备减少）;血管外因素为室间隔肥大从背侧,左室肥厚从左侧挤压壁冠状动脉,高血压时则释放儿茶酚胺刺激心肌细胞蛋白质合成,血管紧张素Ⅱ及醛固酮还可使心肌细胞间的胶元组织增生,加重压迫壁冠状动脉,心肌桥细胞也可增生.     

40层螺旋CT对冠状动脉心肌桥的诊断价值

目的 探讨40层螺旋CT（MSCT）对冠状动脉心肌桥的诊断价值。方法298例可疑冠心病患者行冠脉CT成像，检出心肌桥者根据有否冠心病将其分为单纯心肌桥组和心肌桥合并冠心病组，然后比较两组胸痛的临床特点与40MSCT诊断心肌桥的特点。21例心肌桥者行选择性冠状动脉造影。结果40MSCT心肌桥的检出率为26．8％。80例患者共有122处心肌桥，其中左前降支占51．6％。40MSCT显示胸痛患者心肌桥的厚度多≥2．0mm，发生在左前降支；壁冠状动脉长度≥2．6mm的多发生在回旋支，与无胸痛的心肌桥患者相比差异有显著性。80例心肌桥患者中有胸痛者64例（80．0％）。冠心病组多为典型心绞痛，单纯心肌桥组胸痛不典型。其中21例冠状动脉造影仅9例显示心肌桥。冠心病组所有的心肌桥与狭窄的冠状动脉均非同一处血管。结论MSCT空间分辨力高，可准确判断冠状动脉形态、结构异常和心肌密度异常，并可判断冠状动脉和心肌的空间关系。诊断心肌桥敏感可靠，检出率高，优于冠脉造影。     

96例冠状动脉心肌桥患者临床特征及治疗体会

目的 探讨冠状动脉心肌桥的特征及临床疗效.方法 总结选择性冠脉造影1300例患者的临床资料,对96例冠状动脉心肌桥患者的特征及临床疗效进行分析.结果 96例（男性47例,48.6%）患者中心肌桥主要发生于左冠状动脉前降支94例（97.9%）、回旋支2例（2.1%）,孤立性心肌桥51例（53.1%）,合并单支病变31例（32.3%）、双支病变14例（14.6%）.所有患者均应用β受体阻滞剂和（或）钙通道阻滞剂治疗,70例症状缓解,23例伴＞70%冠状动脉固定狭窄患者对靶血管行PCI,术后症状缓解,1例行冠脉搭桥术.结论 冠状动脉心肌桥多发生于左前降支,男女检出率差异无统计学意义.孤立性心肌桥患者症状多不典型,多数药物治疗效果较好.     

外科治疗心肌桥19例分析△

目的总结19例心肌桥患者的外科治疗经验。方法2006年1月至2011年4月广东省人民医院共收治心肌桥患者19例,男11例,女8例,年龄（53．4±13．9）岁。4例单纯性心肌桥,15例合并有其他心脏疾病。19例均为左冠状动脉前降支心肌桥,近段6例,中段8例,远段5例;埋人心肌冠状动脉长O．5-5cm;收缩期冠状动脉管腔狭窄40％-95％。15例在体外循环下行心肌桥松解术,4例在非体外循环下松解,合并的其他心脏畸形给予同期矫治。结果全组无死亡及术后并发症的发生,随访4个月-5年,均无不适症状。结论外科治疗心肌桥是安全和有效的,不能药物治疗和造成冠状动脉严重狭窄的心肌桥可考虑手术治疗。     

非体外循下心肌桥外科治疗的方法探讨

目的初步探讨微创非体外循下外科治疗心肌桥的方法临床经验和手术后期远期疗。方法 2008年4月至2010年12月,单纯冠状动脉左前降支心肌桥患者13例,均在心脏不停跳下完成心肌桥松解术。手术方法采用和微创非体外循环冠脉搭桥手术一样的操作方法,锐性切开心肌桥上的心肌组织。患者年龄(47.8±13.4)岁,有心肌缺血症状,心电图V1～V5心肌缺血,心肌桥狭窄程度78%±9%,均位于左前降支中段,心肌桥长度(2.1±0.29)cm。结果心肌桥松解术均获得成功,术后心肌缺血症状消失,心电图示心肌缺血改善,平均住院天数(5.5±1.5)d,术中及术后均没有输注血制品,平均SICU时间(20.1±2.2)h,术后均没有使用正性肌力药物,患者术后3个月冠脉造影示心肌桥消失。结论对于病变严重的心肌桥狭窄>50%患者,应该积极干预治疗。治疗方法以心肌桥松解术效果最好,微创非体外循环心脏不停跳比较体外循环心脏停跳下单纯心肌桥松解术有以下优点:(1)避免了体外循环的相关并发症;(2)寻找冠脉更为容易,减少对冠脉的损伤;(3)心肌桥后的心肌保护更好,避免了心脏停跳,更好地保护了心功能;(4)切开的心肌内的止血及时容易;(5)手术效果切实;(6)患者康复快,减少了住院时间和费用。     

小切口肌桥松解术治疗冠状动脉肌桥的临床研究

目的:探讨小切口肌桥松解术治疗冠状动脉肌桥(myocardial bridging,MB)的手术方法及中短期手术效果。方法:2009年9月至2013年11月间,我们对11例MB患者施行了小切口肌桥松解术,其中10例为孤立MB,1例合并前降支—肺动脉瘘。11例患者均有胸痛或胸闷病史,并经过系统的药物治疗,症状仍间断发作。术前均由冠状动脉造影检查明确诊断,肌桥均位于左前降支,长度为2~4cm,收缩期狭窄均60%。结果:11例患者均行胸骨中下段小切口,10例孤立MB患者顺利在非体外下行肌桥松解术,1例行松解时损伤冠状动脉,改行非体外冠状动脉旁路移植术;合并前降支—肺动脉瘘的患者在非体外下行肌桥松解术同时行瘘修补术。无患者死亡,也无心室破裂、肺部感染、肾衰竭等围手术期并发症。术后均顺利出院。术后11例患者均被随访,随访时间2~51个月,10例行肌桥松解术患者中有1例患者术后再次发作胸痛症状,行冠状动脉造影检查未见明显收缩期狭窄,给予药物可控制症状。1例行冠状动脉旁路移植术患者9个月后再发胸痛症状,内科行支架置入治疗。结论:小切口肌桥松解术创伤小、安全性高、疗效可靠,可作为药物控制不佳MB患者的治疗选择。     

Robot-assisted coronary artery bypass grafting improves short-term outcomes compared with minimally invasive direct coronary artery bypass grafting

Background

Robot-assisted coronary artery bypass grafts (RACAB) utilizing the da Vinci surgical system are increasingly used and allow the surgeon to conveniently harvest internal mammary arteries (IMAs). The aim of this study was to compare the outcomes of off-pump RACAB and minimally invasive direct coronary artery bypass grafting (MIDCAB) in the short and medium term.

Methods

We performed a retrospective review of 132 patients with single- or multiple-vessel coronary artery disease who underwent minimally invasive off-pump CABG (OPCAB) between May 2009 and May 2014. The patients were divided into two groups based on the surgical approach, MIDCAB and RACAB group. The anastomosis of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) was performed as regular OPCAB through the incision on the beating heart using regular stabilization devices (Genzyme Corporation). The preoperative, intraoperative, postoperative, and follow-up data, including major adverse cardiac and cerebrovascular events (MACCE), were compared.

Results

The preoperative data were similar. RACAB significantly shorten the intensive care unit (ICU) stay and postoperative compared with the MIDCAB group (P<0.05). There were 12 (19.7%) patients treated with a two-stage hybrid procedure in the MIDCAB group and 34 (47.9%) patients in the RACAB group (P=0.001). Thirty-day mortality was 1.6% in the MIDCAB group. There were 9 (14.7%) MIDCAB patients and 2 (2.8%) RACAB patients (P=0.013) that developed new arrhythmia. The two groups showed comparable mid-term survival (P=0.246), but the MACCEs were significantly different (P=0.038).

Conclusions

RACAB may be a valuable alternative for patients requiring single or simple multi-vessel coronary artery bypass grafting (CABG). Although the mid-term mortality outcomes are similar, RACAB improves short-term outcomes and mid-term MACCE-free survival compared with MIDCAB.     

一站式复合血管重建技术治疗无保护左主干病变

目的 评价一站式复合血管重建技术治疗无保护左主干病变的可行性和安全性.方法 2007年6月至2009年4月共有14例左主干病变患者接受一站式复合血管重建技术再血管化.其中男性13例,女性1例,平均年龄(60.4±15.4)岁,冠状动脉造影显示左主干开口或体部病变5例,远端或分叉病变11例.手术在一站式复合手术室内进行.通过胸骨下段小切口在心脏不停跳状态下行微创冠状动脉旁路移植术(左乳内动脉至前降支旁路移植),同期对左主干病变和(或)其他非前降支病变行经皮冠状动脉介入治疗.结果 14例患者均顺利进行一站式复合手术.即刻冠状动脉造影显示左乳内动脉桥均通畅.共有25处非前降支病变接受经皮冠状动脉介入治疗,其中23处病变置入支架(药物洗脱支架27枚,金属裸支架2枚),其余2处病变仅行冠状动脉球囊扩张术.围术期及随访期间无死亡、围术期心肌梗死、脑卒中或再次再血管化等发生.平均随访7.9个月(1～15个月),所有患者均存活且无再发心绞痛.5例患者术后1年再次接受冠状动脉造影,证实左乳内动脉桥及支架均通畅.结论 一站式复合血管重建技术治疗经选择的无保护左主干病变尤其是合并高危因素者安全可行.     

Coronary aneurysm and stent fracture following stenting of a myocardial bridge

Myocardial bridge is the most common congenital coronary anomaly. We represent an extremely rare case of stent fracture combination with coronary aneurysm following stenting of a myocardial bridge. This 60‐years‐old male patient underwent coronary angiography in the local hospital four years ago. Coronary angiography revealed a myocardial bridge in the distal left anterior descending coronary artery (LAD). A 3.0 mm × 29 mm sirolimus eluting stent was deployed in the distal LAD. Three years later, repeat coronary angiography showed a large coronary aneurysm in the mid segment of the stent. The patient subsequently underwent coronary artery bypass grafting with left internal mammary artery (LIMA) to the distal segment of the LAD. But six months later, another coronary angiography showed a stent fracture in mid portion of the stent associated with a large coronary aneurysm, and the LIMA graft was totally occluded. A possible mechanism of stent fracture was long‐standing and cyclic mechanical stress on the stent by myocardium. These forces over a period of time may lead to metal fatigue and eventually fracture. Based on the observation of fracture and aneurysm in this study, we recommend that myocardial bridge should not be treated with intracoronary stenting. © 2015 Wiley Periodicals, Inc.     

Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease

The purpose of this study was to compare the clinical outcomes of stenting and minimally invasive coronary artery bypass grafting (MIDCAB) in patients with proximal left anterior descending (LAD) coronary artery disease. The Patency, Outcome, Economics of Minimally invasive direct coronary bypass (POEM) study demonstrated that MIDCAB had similar safety and long-term efficacy for LAD revascularization compared with conventional coronary artery bypass grafting. Although LAD stenting is superior to conventional balloon angioplasty, whether it is comparable to MIDCAB is not known. We identified a matched population of 429 consecutive patients with 1-vessel disease who underwent elective proximal LAD stenting and compared their clinical outcomes with those of the 152 patients in the MIDCAB group of the POEM study. The in-hospital event rate was similar in both groups, except for a shorter length of hospital stay with LAD stenting compared with MIDCAB (2.68 vs 4.07 days, p <0.0001). At 6-month follow-up, the incidence of death and Q-wave myocardial infarction or that of cerebrovascular accident was not significantly different between these 2 groups. However, target vessel revascularization was significantly higher with LAD stenting than MIDCAB (13.3% vs 6.6%, p = 0.045). In the subgroup of patients without diabetes, all clinical events were similar in both groups, and the benefit of a shorter hospital stay associated with stenting was maintained. Compared with MIDCAB, LAD stenting is associated with higher repeat revascularization rates but offers the advantage of shorter hospitalization. For nondiabetics with proximal LAD disease, stenting may be the revascularization strategy of choice.     

Mid-term results of conventional bypass surgery for complex proximal left anterior descending coronary artery stenoses.

BACKGROUND: The significant involvement of proximal left anterior descending (LAD) coronary artery affects patient prognosis and must be treated. Recently, as alternative methods to conventional coronary bypass (CABG), minimally invasive direct coronary artery bypass grafting (MIDCAB) and percutaneous transluminal coronary angioplasty with stent implantation (PTCA/S) have been proposed to reduce costs and patient discomfort. The aim of this study was to obtain early and medium-term results of CABG in patients with complex LAD disease in whom the expected results with PTCA/S or MIDCAB would have been suboptimal. METHODS: We retrospectively examined one hundred consecutive patients subjected to isolated CABG who received either a single graft to LAD or several grafts to LAD and diagonal branches. The choice of CABG was due to poor expectable results with PTCA/S or MIDCAB because of anatomical characteristics of the lesion, inclusion in ongoing randomized study comparing surgical versus non-surgical revascularization, or preference on the part of the cardiologist or patient. RESULTS: Left internal mammary artery (LIMA) was grafted to LAD in 99 (99%) patients; 65 (65%) patients received at least one saphenous graft to the diagonal branches. No death was observed within 30 days from the operation. One (1%) patient had a perioperative non-Q myocardial infarction (MI). At a mean follow-up time of 38 +/- 16 months (range 2-60), there were no cardiac deaths and no new MI. Six patients complained of recurrent angina: in all cases but one (vein graft failure to a diagonal branch), there were no clinical or diagnostic signs suggesting other graft failures. The probability of freedom from early and late events, including cardiac death, MI and recurrence of angina regardless of site, was 99% at 1 year and 86% at 5 years. CONCLUSIONS: At present, conventional CABG seems to be the "gold standard palliation" of LAD disease in most cases. It can be performed safely with excellent early and medium-term results in terms of freedom from cardiac events. Its comparison with percutaneous transluminal techniques and MIDCAB needs to be addressed in further prospective studies.     

冠状动脉旁路移植术治疗冠心病的体会

目的 探讨冠状动脉旁路移植术（CABG）对冠心病的治疗效果.方法 2005年7月至2010年 8月共行冠状动脉旁路移植术 82例,年龄38～78（61.8±12.7）岁,病程3个月至12年;有心肌梗死病史13例（15.6%）,合并高血压56例（68.3%）、糖尿病30例（36.5%）.术前心功能（NYHA）Ⅰ～Ⅲ级,Ⅰ级21例、Ⅱ级48例、Ⅲ级13例.手术在全麻体外循环下进行,取大隐静脉（SVG）与左乳内动脉（LIMA）,左乳内动脉与前降支（LAD）搭桥,其余用大隐静脉搭桥,平均每例搭桥（2.60±0.85）根,二尖瓣成形4例.结果 全组死亡1例,死于急性胰腺炎.术后低心排6例、房颤 10例,并发肺不张2例,4例术后引流多,二次开胸止血,1例术后第3天发现上纵隔增宽,二次开胸清除血块.结论 冠状动脉旁路移植术疗效显著,确切恢复和重建心肌血运,手术安全,结果令人满意.     

Minimally invasive direct coronary artery bypass plus coronary stent for acute coronarysyndrome: a case report

A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed 60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a small left circumflex,70-90% stenosis at the paroxysmal and middle part of a dominant right coronary artery (RCA),and a normal left internal mammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occluded lesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davinci robot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then the patient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique be feasible and safe in the treatment of elderly patient with multiple coronary diseases.     

Hybrid-Verfahren zur Myokardrevaskularisation: Stellenwert der Kombination von minimal-invasiver Bypasstechnik (MIDCAB) mit interventioneller Therapie (PTCA)

BACKGROUND: Minimally invasive direct coronary artery bypass (MIDCAB) grafting without cardiopulmonary bypass (CPB) through an anterolateral minithoracotomy has become a promising therapeutical option especially in multimorbid, elderly and reoperative patients with single vessel disease. However, this procedure precludes complete revascularization in multivessel disease because the minithoracotomy limits the surgical access either to anterior or lateral or posterior vessels of the beating heart. To expand the benefits of the MIDCAB concept to patients with multivessel disease, new interdisciplinary approaches have recently been introduced. METHODS: Since December 1996, 26 patients (21 male, 5 female, mean age 56.6 +/- 18.8 years) underwent a "hybrid" revascularization performed as a primary MIDCAB procedure for grafting of the left anterior descending artery (LAD) with the left internal mammary artery (LIMA) followed by staged angioplasty and stenting of additional coronary lesions. RESULTS: After MIDCAB grafting, the postoperative course was uneventful in all patients. Coronary re-angiography after a median of 7 days revealed patent and functioning LIMA grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty (PTCA) and occasional stenting (n = 8), a total of 31 lesions were treated successfully. Procedure related complications did not occur. All patients remained angina-free and no stress electrocardiographic changes were recorded. CONCLUSION: Our preliminary results of a "hybrid" approach to myocardial revascularization suggest that this concept is a safe and effective approach of complete revascularization for selected patients with multivessel involvement. Especially elderly and reoperative patients with significant comorbidity may benefit from hybrid procedures avoiding cardiopulmonary bypass and midsternotomy.     

Hybrid coronary revascularization for the treatment of left main coronary stenosis: a feasibility study

Objective : To determine the feasibility of a hybrid coronary revascularization (HCR) approach for the treatment of left main (LM) coronary artery stenosis. Background : The recommended therapy for significant LM stenosis is coronary artery bypass grafting (CABG). Percutaneous coronary intervention (PCI) of unprotected LM lesions is reserved for patients at high risk for complications with CABG. HCR in LM disease has not been studied. Methods : Twenty‐two consecutive patients with LM stenosis >70% underwent staged HCR. Following a robotic or thoracoscopic‐assisted minimally invasive left internal mammary artery (LIMA) to left anterior descending artery (LAD) coronary bypass, PCI of the LM, and non‐LAD targets was performed after angiographic confirmation of LIMA patency. Intravascular ultrasound confirmed optimal stent deployment. Thirty‐day adverse outcomes and long term follow up was obtained. Results : In the 22 patients with LM lesions, 6 were ostial, 5 mid, and 11 distal. LIMA patency was FitzGibbon A in all cases. LM stenting was successful in all patients with drug‐eluting stents (DES) placed in 21 of 22 cases. Three patients underwent stent implantation in the right coronary artery. There were no 30‐day major adverse cardiac or cerebrovascular events. At a mean of 38.8 ± 22 months postprocedure, 21 patients were alive without reintervention; one death occurred at 454 days. Conclusions : HCR for LM coronary disease is a feasible alternative to CABG and unprotected LM PCI. This approach combines the long‐term durability of a LIMA‐LAD bypass with the less invasive option of PCI in non‐LAD targets with DES. © 2011 Wiley Periodicals, Inc.