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Ann Thorac Surg 1998;66:1076-1081
© 1998 The Society of Thoracic Surgeons

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Supplement

Beating heart operations including hybrid revascularization: initial experiences

^a Department of Cardiac Surgery, Hamburg, Germany
^c Department of Cardiology, Albertinen-Krankenhaus, Hamburg, Germany
^b Center of Cardiology, Hamburg-Othmarschen, Hamburg, Germany

Address reprint requests to Dr Riess, Albertinen-Krankenhaus Abt für Herzchirurgie, Suentelstrasse 11 a, 22457 Hamburg, Germany

Presented at "Facts and Myths of Minimally Invasive Cardiac Surgery: Current Trends in Thoracic Surgery IV," New Orleans, LA, Jan 24, 1998.

Abstract

Background. The outcome of patients (n = 45) with coronary one- to three-vessel disease undergoing beating heart operations using a recently developed stabilizing device was investigated.

Methods. Left internal mammary artery-to-left anterior descending coronary artery (LIMA-to-LAD) revascularization was carried out alone (n = 31) or as hybrid procedure in combination with a balloon angioplasty (n = 14).

Results. All 45 patients underwent a successful LIMA-to-LAD procedure without intraoperative complication during a 21 ± 8-minute (range, 10 to 53 minutes) LAD occlusion time. In 14 hybrid procedures a total of 19 stenoses including 3 left main stenoses were treated successfully by percutaneous transluminal coronary angioplasty and stenting. The postoperative courses were uneventful with the exception of two surgical reexplorations necessitated by bleeding. No worsening of renal, neurologic, or respiratory functions occurred in any patient. In the group having a single LIMA-to-LAD procedure, early postoperative coronary angiograms (22 of 31) showed a patent LIMA graft and excellent anastomosis; this was also true in 4 patients 12 months after operation as shown in angiograms. All patients undergoing hybrid revascularization demonstrated a patent LIMA-to-LAD anastomosis; in 1 patient there was a dissection in the midlevel of the LIMA, which was stented successfully. The 6-month follow-up angiograms in 7 of 14 patients revealed open LIMA bypass grafts in all patients except 1, who was stented because of dissection.

Conclusions. These data indicate that a beating heart operation including hybrid revascularization is safe and effective in selected patients with coronary one- to three-vessel disease including left main stenosis. This approach may be especially advantageous in comparison with conventional coronary artery bypass grafting in patients with severe concomitant disease.

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