Hybrid Off-pump Coronary Artery Bypass Combined with Percutaneous Coronary Intervention: Indications and Early Results.
- Author:
Ho Young HWANG
1
;
Jin Hyun KIM
;
Kwang Ree CHO
;
Ki Bong KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, Korea. kimkb@snu.ac.kr
- Publication Type:Original Article
- Keywords:
Coronary artery bypass;
Angioplasty, transluminal, percutaneous coronary;
Minimally invasive surgery;
Off pump
- MeSH:
Angioplasty, Balloon, Coronary;
Aorta;
Atrial Fibrillation;
Constriction, Pathologic;
Coronary Angiography;
Coronary Artery Bypass;
Coronary Artery Bypass, Off-Pump*;
Coronary Vessels;
Follow-Up Studies;
Heart Failure;
Humans;
Mortality;
Myocardial Infarction;
Percutaneous Coronary Intervention*;
Stents;
Surgical Procedures, Minimally Invasive;
Survivors;
Transplants
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2005;38(11):733-738
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: The possibility of incomplete revascularization and development of flow competition after revascularization of the borderline lesion made the hybrid strategy as an option for complete revascularization. MATERIAL AND METHOD: From January 1998 to July 2004, 25 (3.2%) patients underwent hybrid revascularization among 782 total OPCAB procedures. Clinical results and angiographic patencies were evalulated. Percutaneous coronary intervention (PCI) was performed before CABG in 8 patients and after CABG in 17 patients. RESULT: The causes of PCIs before CABG were to achieve complete revascularization with minimally invasive surgery (n=7) and emergent PCI for culprit lesion (n=1). The indications of PCIs after CABG were high possibility of flow competition in the borderline lesion of right coronary artery territory (n=8), diffuse atheromatous lesion preventing anastomosis of graft (n=5), severe calcified ascending aorta with no more arterial graft available (n=3), and intramyocardial coronary lesion (n=1). Mean number of distal anastomoses was 2.3+/-1.0. Mean number of lesions treated by PCI was 1.2+/-0.4. There was no operative or procedure-related mortality. PCI-related complication was periprocedural myocardial infarction in one patient, and complications related to CABG were transient atrial fibrillation (n=5), perioperative myocardial infarction (n=1), and transient renal dysfunction (n=1). Early postoperative coronary angiography (1.8+/-1.6 days) revealed 100% patency rate of grafts (57/57). The stenosis occurred in one patient performed PCI before CABG, which was successfully treated with re-ballooning. During midterm follow-up (mean; 25+/-26 months), 1 patient died of congestive heart failure. All survivors (n=24) accomplished follow-up coronary angiographics, which showed all grafts (56/57) were patent except one string sign. In-stent restenosis was developed in 2 patients who received bare metal stents. CONCLUSION: In selected patients, complete revascularization was achieved with low risk by taking the hybrid strategy.
