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Best practice in hybrid coronary revascularization
Stephan Jacobs, Simon Sündermann, Volkmar Falk.
University of Zürich Departement of Cardiovascular Suregry, Zürich, Switzerland.

OBJECTIVE: Here we report the results of 30 patients, scheduled for Hybrid revascularization and PCI to non-LAD vessels.
METHODS: From April 2011, revascularization of the left anterior descending artery was performed in 30 patients by minimally invasive direct coronary artery bypass grafting (MIDCAB) followed by Percutaneous coronary intervention (PCI) of vessels other than the left anterior descending artery in a single procedure. All operations were performed in a surgical hybrid suite. MIDCAB was performed first followed by PCI using drug eluting stents (DES).
RESULTS: MIDCAB and stenting were completed in all patients as planned. Mean age was 64,4 years. Preoperatively calculated mean EuroSCORE (European System for Cardiac Risk Evaluation) was 4.04%. 30% of the patients received coronary interventions at two non-LAD vessels. Angiography confirmed patency of all LIMA grafts. Mean intervention time was 120,35 minutes. No thoracotomy for bleeding was required, nor need for blood cell products obtained. Mean ICU stay was 0,83 days with an intubation time of 2,8 hours and hospitalization of 7,64 days. Kaplan-Meier survival was 100% (95% confidence interval [CI]: 93.8% to 98.4%) at 1 year. Freedom from major adverse cardiac and cerebral events (including reintervention) and angina was 100% (95% CI: 96.9% to 99.1%) at 1 year.
CONCLUSIONS: Minimally invasive hybrid coronary revascularization, combining MIDCAB and PCI to non-LAD vessels, is a safe approach with excellent short-term results


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