Heart 2000;83:58-63 ( January )

Interventional cardiology surgery

Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study T Wittwer^a, J Cremer^b, P Boonstra^c, J Grandjean^c, M Mariani^c, A Mügge^d, H Drexler^d, P den Heijer^e, E-R v Leitner^f, A Hepp^g, M Wehr^h, A Haverich^a

^a Department of Cardiothoracic and Vascular Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany, ^b Department of Cardiac and Vascular Surgery, University of Kiel, Germany, ^c Thorax Center, University Hospital Groningen, Groningen, Netherlands, ^d Department of Cardiology, Hannover Medical School, Hannover, Germany, ^e Department of Cardiology, University Hospital Groningen, ^f Department of Cardiology, Krankenhaus Siloah, Hannover, Germany, ^g Department of Cardiology, Vinzenzkrankenhaus, Hannover, Germany, ^h Department of Cardiology, Augusta- Kranken-Anstalt, Bochum, Germany

Correspondence to: Dr Wittwer email: Th.Wittwer-MD{at}t-online.de

Accepted 17 July 1999

OBJECTIVETo expand the benefits of the minimally invasive direct coronary artery bypass (MIDCAB) concept to patients with multivessel disease, a hybrid procedure combining surgical revascularisation of the left anterior descending artery with interventional procedures for additional coronary lesions has recently been introduced. Preliminary results in patients undergoing this hybrid procedure are presented.
DESIGN AND PATIENTSSince December 1996, 35 patients (29 male, 6 female, mean (SD) age 56.7 (17) years) underwent a hybrid revascularisation performed as a primary MIDCAB procedure for grafting of the left anterior descending artery with the left internal mammary artery, followed by staged angioplasty and stenting of additional coronary lesions.
RESULTSAfter MIDCAB grafting the postoperative course was uneventful in all patients. Coronary reangiography after a median of seven days revealed patent and functioning left internal mammary artery grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty and occasional stenting (n = 14), a total of 47 lesions were treated successfully. Procedure related complications did not occur. All patients remained free from angina and no stress ECG changes were recorded.
CONCLUSIONSThe preliminary results of this hybrid approach to myocardial revascularisation suggest that this is a safe and effective procedure for complete revascularisation in selected patients with multivessel disease. Elderly and reoperative patients with significant comorbidity may benefit especially from such hybrid procedures by avoiding cardiopulmonary bypass and mid sternotomy.


Keywords: hybrid revascularisation; minimally invasive cardiac surgery; interventional treatment; multivessel revascularisation

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© 2000 by Heart
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