Hybrid Myocardial Revascularization
Pavlov Alexandr Anatolevich, Sr., Shneider Yuri Alexandrovich, Tsoy Victor Gennadievich.
FSBI "Federal Center for High Medical Technologies" (Kaliningrad, Russia)., Kaliningrad, Russian Federation.
OBJECTIVES: The aim of this study was to present our own experience in the treatment of coronary artery disease using hybrid technologies. METHODS: 427 consecutive patients underwent hybrid coronary revascularization. Male were 298 (66,8%), mean age was 65.2±18.1 years. Patients were stratified according to the Euroscore II scale, 2.5 ± 3.1. The first stage (CABG mostly) was performed in off pump conditions; 369 (86.4%) had a minileft-sided thoracotomy, 17 (4 %) patients underwent a median sternotomy (operations, chest injuries in the anamnesis), 41 (9,6%) had PCI. The LIMA was used as a graft in situ 375 (97.3%), 12 (2.8%) patients with reoperation (due to the absence of LIMA) - autovenous subclavian-coronary bypass. The second stage (PCI mostly) was performed within a period of up to 60 days, usually in the same hospitalization. The time interval depended on the characteristics of the postoperative recovery period, the technical features of the forthcoming operation. RESULTS: There were no cases of conversion to sternotomy after minithoracotomy. The average stay in the intensive care unit was 1.1, stay in the hospital 6.1 bed / day. The early postoperative period (after the first stage) in 7 (1,6%) patients was complicated by bleeding, which required revision of the wound. In 29 (6.8%) there was a rhythm disturbance in the type of atrial fibrillation (AF), drug-induced. Superficial suppuration of the postoperative wound took place in 5 (1.2%) cases. Lethal cases were absent. The second stage: (PCI) was performed on a planned basis in 386 (90.4%) patients; 41 (9,6%) patients underwent CABG. One patient (0.2%) died from stroke, which was a complication of stent thrombosis on day 3 after stenting. CONCLUSIONS: Hybrid myocardial revascularization show good immediate results in patients of different age categories, patients with concomitant pathology, in patients with previous cardiosurgical interventions. The final evaluation of the method is possible after follow-up trials.
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