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Correspondence

Reply

Department of Cardiovascular Surgery, University Hospital Zurich, Raemistrasse 100, Zurich, 8091 Switzerland

(Email: dholzhey{at}web.de).

To the Editor:

In the letter by Gomes [1], the experience with performing hybrid coronary revascularization during a period of approximately 10 years is described. Within that time period, both opinions and practice in cardiology and cardiac surgery have changed and are continuing to change.

Particularly in the light of the latest large trials, such as the Synergy between PCI with Taxus and Cardiac Surgery trial, as the first choice for multi-vessel coronary disease should be complete surgical revascularization to achieve the best long-term benefit.

From our experience, hybrid procedures have their place in accompanying medical circumstances short-term, and mid-term quality-of-life improvement, plus the shortest possible recovery time, outweighs the possible long-term benefit of a primary complete surgical approach [2].

In Gomes' letter [1], an interesting question is added to the discussion. After a minimally invasive revascularization of the left anterior descending artery, is an additional percutaneous intervention for the remaining lesions still necessary in asymptomatic patients? The evidence on this topic is poor, but indirect conclusions from other trials suggest that medical therapy alone might be sufficient for these patients.

We agree that a randomized trial should deal with that particular topic. Up to now, only low total numbers of hybrid cases have been reported in the literature. A dedicated multicenter approach would therefore be necessary to provide enough power for a trial to answer that question. The effort may be worthwhile, because it might not only change our way we look at hybrid procedures, but it can also help us to evaluate the significance of complete revascularization.

	References

Top References

 

1. Gomes WJ. Hybrid coronary artery revascularization: an evidence-based analysis (letter) Ann Thorac Surg 2009;88:1047.[Free Full Text]
2. Holzhey DM, Jacobs S, Mochalski M, et al. Minimally invasive hybrid coronary artery revascularization Ann Thorac Surg 2008;86:1856-1860.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): David Holzhey Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Holzhey, D. Search for Related Content PubMed PubMed Citation Articles by Holzhey, D. Related Collections Related Article