Hybrid coronary revascularization

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ;Associate Editor-In-Chief: Mohammed A. Sbeih, M.D.[2] Phone:617-849-2629

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Overview

Hybrid coronary bypass is a relatively new procedure and alternative to traditional bypass surgery that is defined by the performance of coronary bypass surgery and coronary stenting during the same operation. It is not to be confused with a MIDCAB procedure, which uses the smaller thoracotomy incision but does not involve coronary stenting. Hybrid bypass offers all the benefits of a MIDCAB:

  1. A much smaller incision (made through the rib cage as opposed to cutting the sternum and opening the rib cage) than with traditional bypass surgery.
  2. Less pain for the patient and quicker recovery time.
  3. Less risk of complications, infections etc and also decreases the necessity for two separate cardiac procedures (bypass and stenting).

Not all hospitals and/or surgeons offer this procedure and it requires a specially equipped OR. As such, it is worth inquiring to determine which hospitals do and whether or not a patient can benefit from this procedure.

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1]

Hybrid Coronary Revascularization (DO NOT EDIT)[1]

Class IIa

"1. Hybrid coronary revascularization (defined as the planned combination of left internal mammary artery-to-LAD artery grafting and PCI of ≥1 non-LAD coronary arteries) is reasonable in patients with 1 or more of the following[2][3][4][5][6][7][8]:

a. Limitations to traditional CABG, such as heavily calcified proximal aorta or poor target vessels for CABG (but amenable to PCI);(Level of Evidence: B)
b. Lack of suitable graft conduits; (Level of Evidence: B)
c. Unfavorable LAD artery or PCI (i.e., excessive vessel tortuosity or chronic total occlusion). (Level of Evidence: B)"
Class IIb

"1. Hybrid coronary revascularization (defined as the planned combination of left internal mammary artery-to-LAD artery grafting and PCI of ≥1 non-LAD coronary arteries) may be reasonable as an alternative to multivessel PCI orCABG in an attempt to improve the overall risk-benefit ratio of the procedures. (Level of Evidence: C)"

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References

  1. 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. PMID 22070837. doi:10.1016/j.jacc.2011.08.006. Retrieved 2011-12-08.  Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  2. Zhao DX, Leacche M, Balaguer JM, Boudoulas KD, Damp JA, Greelish JP, Byrne JG, Ahmad RM, Ball SK, Cleator JH, Deegan RJ, Eagle SS, Fong PP, Fredi JL, Hoff SJ, Jennings HS, McPherson JA, Piana RN, Pretorius M, Robbins MA, Slosky DA, Thompson A (2009). "Routine intraoperative completion angiography after coronary artery bypass grafting and 1-stop hybrid revascularization results from a fully integrated hybrid catheterization laboratory/operating room". Journal of the American College of Cardiology. 53 (3): 232–41. PMID 19147039. doi:10.1016/j.jacc.2008.10.011. Retrieved 2011-12-06.  Unknown parameter |month= ignored (help)
  3. Vassiliades TA, Douglas JS, Morris DC, Block PC, Ghazzal Z, Rab ST, Cates CU (2006). "Integrated coronary revascularization with drug-eluting stents: immediate and seven-month outcome". The Journal of Thoracic and Cardiovascular Surgery. 131 (5): 956–62. PMID 16678575. doi:10.1016/j.jtcvs.2005.10.058. Retrieved 2011-12-06.  Unknown parameter |month= ignored (help)
  4. Bonatti J, Schachner T, Bonaros N, Jonetzko P, Ohlinger A, Ruetzler E, Kolbitsch C, Feuchtner G, Laufer G, Pachinger O, Friedrich G (2008). "Simultaneous hybrid coronary revascularization using totally endoscopic left internal mammary artery bypass grafting and placement of rapamycin eluting stents in the same interventional session. The COMBINATION pilot study". Cardiology. 110 (2): 92–5. PMID 17971657. doi:10.1159/000110486. Retrieved 2011-12-06. 
  5. Gilard M, Bezon E, Cornily JC, Mansourati J, Mondine P, Barra JA, Boschat J (2007). "Same-day combined percutaneous coronary intervention and coronary artery surgery". Cardiology. 108 (4): 363–7. PMID 17308384. doi:10.1159/000099110. Retrieved 2011-12-06. 
  6. Holzhey DM, Jacobs S, Mochalski M, Merk D, Walther T, Mohr FW, Falk V (2008). "Minimally invasive hybrid coronary artery revascularization". The Annals of Thoracic Surgery. 86 (6): 1856–60. PMID 19021994. doi:10.1016/j.athoracsur.2008.08.034. Retrieved 2011-12-06.  Unknown parameter |month= ignored (help)
  7. Kon ZN, Brown EN, Tran R, Joshi A, Reicher B, Grant MC, Kallam S, Burris N, Connerney I, Zimrin D, Poston RS (2008). "Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass". The Journal of Thoracic and Cardiovascular Surgery. 135 (2): 367–75. PMC 2962576Freely accessible. PMID 18242270. doi:10.1016/j.jtcvs.2007.09.025. Retrieved 2011-12-06.  Unknown parameter |month= ignored (help)
  8. Reicher B, Poston RS, Mehra MR, Joshi A, Odonkor P, Kon Z, Reyes PA, Zimrin DA (2008). "Simultaneous "hybrid" percutaneous coronary intervention and minimally invasive surgical bypass grafting: feasibility, safety, and clinical outcomes". American Heart Journal. 155 (4): 661–7. PMC 2636970Freely accessible. PMID 18371473. doi:10.1016/j.ahj.2007.12.032. Retrieved 2011-12-06.  Unknown parameter |month= ignored (help)

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