Correspondence
Preliminary Experience with Minimally Invasive Coronary-Artery Bypass Surgery Combined with Coronary Angioplasty
N Engl J Med 1997; 336:1454-1455May 15, 1997
- Article
To the Editor:
Percutaneous transluminal coronary angioplasty (PTCA) and coronary-artery bypass grafting (CABG) are both known to be highly effective in the treatment of coronary disease.1,2 Many recent trials have compared PTCA with CABG in single-vessel as well as multivessel coronary disease. Both procedures provide good clinical results with similar five-year survival rates.3,4
The introduction of minimally invasive coronary-artery bypass surgery permits less invasive coronary revascularization by obviating the need for cardiopulmonary bypass and sternotomy.5 In two selected patients with two-vessel disease, we attempted complete coronary revascularization with a combined strategy of minimally invasive surgery and balloon angioplasty (“hybrid revascularization”). As a first step, both patients underwent minimally invasive surgery with left-internal-thoracic-artery grafting to the left anterior descending artery. Both procedures were performed on the beating heart without the use of cardiopulmonary bypass. In a second step (within two days), PTCA was successfully performed in a stenosed right coronary artery. Both patients had marked improvement of angina symptoms and no signs of myocardial ischemia.
During short-term follow-up, no major complications (myocardial infarction, need for coronary reintervention, or blood loss requiring transfusions) occurred. Coronary angiography before PTCA of the right coronary artery showed patent internal-thoracic-artery grafts with excellent bypass perfusion. The patients were discharged within 10 days. This new approach to coronary revascularization warrants further evaluation in larger studies.
5 ReferencesGuy J. Friedrich, M.D.
Johannes Bonatti, M.D.
Otto E. Dapunt, M.D.
University Hospital Innsbruck, A-6020 Innsbruck, Austria1
The Veterans Administration Coronary Artery Bypass Surgery Cooperative Study Group
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- Citing Articles (21)
Citing Articles
1
J. Bonatti, E. J. Lehr, M. Vesely, G. Friedrich, T. Schachner, N. Bonaros, B. Griffith, D. Zimrin. (2011) Hybrid coronary revascularization – techniques and outcome. European Surgery 43:4, 198-204
CrossRef2
Nikolaos Bonaros, Thomas Schachner, Dominik Wiedemann, Felix Weidinger, Eric Lehr, David Zimrin, Guy Friedrich, Johannes Bonatti. (2011) Closed chest hybrid coronary revascularization for multivessel disease ??? current concepts and techniques from a two-center experience. European Journal of Cardio-Thoracic Surgery
CrossRef3
Changqing Gao, Ming Yang, Yang Wu, Gang Wang, Cangsong Xiao, Hongbin Liu, Caiyi Lu. (2009) Hybrid Coronary Revascularization by Endoscopic Robotic Coronary Artery Bypass Grafting on Beating Heart and Stent Placement. The Annals of Thoracic Surgery 87:3, 737-741
CrossRef4
Martine Gilard, Eric Bezon, Jean C. Cornily, Jacques Mansourati, Philippe Mondine, Jean A. Barra, Jacques Boschat. (2007) Same-Day Combined Percutaneous Coronary Intervention and Coronary Artery Surgery. Cardiology 108:4, 363-367
CrossRef5
Johannes Bonatti, Thomas Schachner, Nikolaos Bonaros, Günther Laufer, Christian Kolbitsch, Josef Margreiter, Patrycja Jonetzko, Otmar Pachinger, Guy Friedrich. (2005) Robotic Totally Endoscopic Coronary Artery Bypass and Catheter Based Coronary Intervention in One Operative Session. The Annals of Thoracic Surgery 79:6, 2138-2141
CrossRef6
Davy C. Cheng, Daniel Bainbridge, Janet E. Martin, Richard J. Novick. (2005) Does Off-pump Coronary Artery Bypass Reduce Mortality, Morbidity, and Resource Utilization When Compared with Conventional Coronary Artery Bypass? A Meta-analysis of Randomized Trials. Anesthesiology 102:1, 188-203
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Friedrich-Christian Riess, Ralf Bader, Peter Kremer, Clemens Kühn, Joachim Kormann, Detlef Mathey, Sina Moshar, Thilo Tuebler, Niels Bleese, Joachim Schofer. (2002) Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up. The Annals of Thoracic Surgery 73:6, 1849-1855
CrossRef8
Yasushi Matsumoto, Masamitsu Endo, Fuminori Kasashima, Yoshinobu Abe, Ikuko Kosugi, Yasumitsu Hirano, Hisao Sasaki, Takeshi Ueyama. (2001) Hybrid revascularization feasibility in minimally invasive direct coronary artery bypass grafting combined with percutaneous transluminal coronary angioplasty in patients with acute coronary syndrome and multivessel disease. The Japanese Journal of Thoracic and Cardiovascular Surgery 49:12, 700-705
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Thorsten Wittwer, Jochen Cremer, Uwe Klima, Thorsten Wahlers, Axel Haverich. (1999) Myocardial “hybrid” revascularization: Intermediateresults of an alternative approach to multivessel coronary artery disease. The Journal of Thoracic and Cardiovascular Surgery 118:4, 766-767
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Clinton T Lloyd, Antonio M Calafiore, Peter Wilde, Raimondo Ascione, Leonardo Paloscia, Christopher R Monk, Gianni D Angelini. (1999) Integrated left anterior small thoracotomy and angioplasty for coronary artery revascularization. The Annals of Thoracic Surgery 68:3, 908-911
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Marco Zenati, Howard A. Cohen, Bartley P. Griffith. (1999) Alternative approach to multivessel coronary disease with integrated coronary revascularization. The Journal of Thoracic and Cardiovascular Surgery 117:3, 439-446
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J. Bonatti, M. Grimm, L. Ch. Müller, G. Friedrich, M. Haisjackl, G. Laufer, J. Walter, S. Sandner, M. Muhm, E. Wolner, F. Gschnitzer. (1998) Minimal invasive Koronarchirurgie — erste gemeinsame Erfahrungen an den Universitätskliniken Innsbruck und Wien. European Surgery 30:1, 7-10
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(1997) More on “Hybrid Revascularization”. New England Journal of Medicine 337:12, 861-862
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