BEATING HEART OPERATIONS INCLUDING HYBRID REVASCULARIZATION - INITIALEXPERIENCES

Background. The outcome of patients (n = 45) with coronary one- to thr ee-vessel disease undergoing beating heart operations using a recently developed stabilizing device was investigated. Methods. Left internal mammary artery-to-left anterior descending coronary artery (LIMA-to-L AD) revascularization was carried out alone (n = 31) or as hybrid proc edure in combination with a balloon angioplasty (n = 14). Results. All 45 patients underwent a successful LIMA-to-LAD procedure without intr aoperative complication during a 21 +/- 8-minute (range, 10 to 53 minu tes) LAD occlusion time. In 14 hybrid procedures a total of 19 stenose s including 3 left main stenoses were treated successfully by percutan eous transluminal coronary angioplasty and stenting. The postoperative courses were uneventful with the exception of two surgical reexplorat ions necessitated by bleeding. No worsening of renal, neurologic, or r espiratory functions occurred in any patient. In the group having a si ngle LIMA-to-LAD procedure, early postoperative coronary angiograms (2 2 of 31) showed a patent LIMA graft and excellent anastomosis; this wa s also true in 4 patients 12 months after operation as shown in angiog rams. All patients undergoing hybrid revascularization demonstrated a patent LIMA-to-LAD anastomosis; in I patient there was a dissection in the midlevel of the LIMA, which was stented successfully. The 6-month follow-up angiograms in 7 of 14 patients revealed open LIMA bypass gr afts in all patients except 1, who was stented because of dissection. Conclusions. These data indicate that a beating heart operation includ ing hybrid revascularization is safe and effective in selected patient s with coronary one- to three-vessel disease including left main steno sis, This approach may be especially advantageous in comparison with c onventional coronary artery bypass grafting in patients with severe co ncomitant disease.