Hybrid Coronary Artery Revascularization: Logistics and Program Development
DOI:
https://doi.org/10.1532/HSF98.20051134Abstract
Planning hybrid coronary artery revascularization--a combination of cardiac surgery with percutaneous procedures-- requires, at first sight, a very complex logistical setup. Technical and equipment related details should be defined as early as possible in order to have time for training of all OR personnel involved. The most challenging aspect in OR-located hybrid coronary revascularization remains a very close cooperation of cardiac surgeons and interventional cardiologists. This teamwork does include indication findings and subsequent referral of multivessel coronary artery disease patients to hybrid procedures, as well as high individual flexibility of interventionalists and surgeons. The major prerequisite for this cooperation is a mutual acceptance of different revascu-larization approaches and the intent to combine their most striking advantages. Intraoperative graft angiography during coronary artery bypass grafting (CABG) procedures is one important step toward simultaneous hybrid coronary revascu-larization procedures. We describe our experience with on table angiography using a mobile C-arm for intraoperative imaging. This fluoroscopy system can in selected cases be used for simultaneous hybrid procedures.References
Angelini GD, Wilde P, Salerno TA, Bosco G, Calafiore AM. 1996. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet 34:757-8.nBonatti J, Danzmayr M, Scahchner T, Friedrich G. 2003. Intraoperative angiography for quality control in MIDCAB and OPCAB. Eur J Cardio-thorac Surg 24:647-9.nBonatti J, Schachner T, Bonaros N, et al. 2005. Robotic totally endoscopic coronary artery bypass and catheter based intervention in one session. Ann Thorac Surg (in press).nBoylan MJ, Lytle BW, Loop FD, et al. 1994. Surgical treatment of isolated left anterior descending coronary stenosis. Comparison of left internal mammary artery and venous autograft at 18 to 20 years of follow-up. J Thorac Cardiovasc Surg 107:657-62.nCisowski M, Morawski W, Drzewiecki J, et al. 2002. Integrated mini mally invasive direct coronary artery bypass grafting and angioplasty for coronary artery revascularization. Eur J Cardiothorac Surg 22:261-5.nFriedrich GJ, Bonatti J, Dapunt OE. 1997. Preliminary experience with minimally invasive coronary-artery bypass surgery combined with coronary angioplasty. N Engl J Med 336:1454-5.nGoldstein JA, Safian RD, Aliabadi D, et al. 1998. Intraoperative angiography to assess graft patency after minimally invasive coronary bypass. Ann Thorac Surg 66:1978-82.nHirshfeld JW Jr, Schwartz JS, Jugo R, et al. 1991. Restenosis after coronary angioplasty: a multivariate statistical model to relate lesion and procedure variables to restenosis. The M-HEART Investigators. J Am Coll Cardiol 18:647-56.nIzzat MB, Khaw KS, Atassi W, Yim AP, Wan S, El-Zufari MH. 1999. Routine intraoperative angiography improves the early patency of coronary grafts performed on the beating heart. Chest 115:987-90.nMack MJ, Brown DL, Sankaran A. 1997. Minimally invasive coronary bypass for protected left main coronary stenosis angioplasty. Ann Thorac Surg 64:545-6.nMack MJ, Magovern JA, Acuff TA, et al. 1999. Results of graft patency by immediate angiography in minimally invasive coronary artery surgery. Ann Thorac Surg 68:383-9.nMoses JW, Leon MB, Popma JJ, et al. 2003. SIRIUS Investigators. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315-23.nRiess FC, Schofer J, Kremer P, et al. 1998. Beating heart operations including hybrid revascularization: initial experiences. Ann Thorac Surg 66:1076-81.nStahl KD, Boyd WD, Vassiliades TA, Karamanoukian HL. 2002. Hybrid robotic coronary artery surgery and angioplasty in multivessel coronary artery disease. Ann Thorac Surg 74:S1358-62.nTatoulis J, Buxton BF, Fuller JA. 2004. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg 77:93-101.nWittwer T, Cremer J, Klima U, Wahlers T, Haverich A. 1999. Myocardial "hybrid" revascularization: intermediate results of an alternative approach to multivessel coronary artery disease. J Thorac Cardiovasc Surg 118:766-7.n
