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Original Articles: Adult Cardiac

Minimally Invasive Hybrid Coronary Artery Revascularization

Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany

Accepted for publication August 13, 2008.

^_* Address correspondence to Dr Holzhey, Herzzentrum Leipzig, Strümpellstrabe 39, Leipzig, 04289, Germany (Email: dholzhey{at}web.de).

Background: Here we report the short- and long-term results of a minimally invasive hybrid approach in 117 patients.

Methods: From 1996 to 2007, revascularization of the left anterior descending artery was performed in 1,696 patients by minimally invasive direct coronary artery bypass grafting (MIDCAB), in 89 patients by beating-heart totally endoscopic coronary artery bypass grafting (TECAB) and in 30 patients by arrested-heart TECAB. Of these patients, 117 were scheduled for a hybrid procedure. Revascularization of the left anterior descending artery was performed by either MIDCAB (107 patients), beating-heart TECAB (8 patients) or arrested-heart TECAB (2 patients). Percutaneous coronary intervention of vessels other than the left anterior descending artery was performed 4 to 6 weeks preoperatively (53 cases), intraoperatively (5 cases), or 2 to 45 days postoperatively (59 cases). Demographic data, perioperative outcome, and annual follow-up were obtained from all patients.

Results: Minimally invasive bypass and stenting could be completed in all patients. Two high-risk patients (1.9%) died postoperatively. Follow-up of all patients adds up to 208 patient-years. Eight patients died during follow-up. Kaplan-Meier survival was 92.5% (95% confidence interval [CI]: 86.5% to 98.4%) at 1 year and 84.8% (95% CI: 73.5% to 94.9%) at 5 years. Follow-up angiogram of symptomatic patients showed 1 bypass occlusion and 5 in-stent restenosis with need for reintervention. Freedom from major adverse cardiac and cerebral events (including reintervention) and angina was 85.5% (95% CI: 76.9% to 94.1%) at 1 year and 75.5% (95% CI: 62.7% to 87.3%) at 5 years.

Conclusions: Minimally invasive hybrid coronary revascularization is a safe approach with good long-term results. It should be performed in selected patients at centers with considerable experience in minimally invasive bypass surgery and requires close cooperation between cardiologists and surgeons.

Related Article

Invited Commentary

Turki Albacker
Ann. Thorac. Surg. 2008 86: 1860. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				W. J. Gomes Hybrid coronary artery revascularization: an evidence-based analysis. Ann. Thorac. Surg., September 1, 2009; 88(3): 1047 - 1047. [Full Text] [PDF]

				D. Holzhey Reply Ann. Thorac. Surg., September 1, 2009; 88(3): 1047 - 1048. [Full Text] [PDF]

				T. Albacker Invited Commentary Ann. Thorac. Surg., December 1, 2008; 86(6): 1860 - 1860. [Full Text] [PDF]