Daniel Swistel | PubMed Health

PubMed2004

Hybrid revascularization using percutaneous coronary intervention and robotically assisted minimally invasive direct coronary artery bypass surgery.

Hybrid revascularization (HR) combines staged percutaneous coronary intervention (PCI) on stenoses in the non-left anterior descending (LAD) territories with minimally invasive direct coronary artery bypass (MIDCAB) using the left internal thoracic artery (LITA) to the LAD. The LITA-to-LAD graft, which has a 5-year patency rate of 95%, is the major determinant of the long-term survival for patients. Thus, HR aims to perform full revascularization without compromising the survival advantage of the LITA-to-LAD graft, while preserving the minimally invasive advantages associated with the percutaneous treatment of symptomatic coronary stenoses. We investigated whether HR was a valid alternative to conventional coronary artery bypass graft surgery in patients with multivessel coronary artery disease. We also present our early experiences with HR using a combined approach of advanced PCI and robotically-assisted MIDCAB.

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PubMedDate not supplied

What is the mortality and recuperative difference of bilateral versus single thoracic artery coronary revascularization in patients with reoperation or over 80 years of age?

BACKGROUND: We examined whether bilateral internal thoracic artery revascularization (BITA) is safe for reoperative coronary revascularization (reop CABG) or primary CABG at age > or = 80 (CABG > or = 80 yrs) as, these two groups are thought to be at higher risk for death or sternal infection. METHODS: We analyzed 329 such patients between January 1, 1993 and March 31, 2002. These are subgroups of 3200 prospectively New York State risk stratified patients for BITA or SITA (single internal thoracic artery revascularization) of equivalent preoperative risk. In 37/39, BITA > or = 80 since 1996 (1996 > or = 80) the microscope was used and the free right internal thoracic artery was anastomosed to the aorta. Long-term survival was analyzed by Kaplan-Meier curves and in particular among the 36 patients between 1996 and 1997, who were operated five and six years ago (1997 > or = 80). CONCLUSIONS: Mortality and recuperative difference of BITA versus SITA in the reop CABG and CABG > or = 80 years are negligible, as there was no significant difference in hospital mortality, sternal infections, LOS, or Kaplan-Meier survival curves and average long-term survival. However BITA appears to have long-term advantage over SITA in the newer period and beyond 48 months (1996-1997 > or = 80).

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