Hybrid revascularization

Objective. To evaluate our initial experience in the combination of two les s invasive procedures for myocardial revascularization,;coronary artery byp ass grafting without cardiopulmonary bypass and immediate posterior angiopl asty, on untreated lesions (hybrid revascularization) as an alternative tre atment to conventional surgery in selected patients. Material and methods. From october 1996 to September 1998, 19 patients rece ived hybrid revascularization. The mean age tvas 64 (47-76). Two patients u nderwent; urgent surgery. Two patients had left main coronary disease, and 9 three-vessel disease, In general, we considered this procedure for patients with high-risk factor s for cardiopulmonary bypass and two or more vessel disease. The internal m ammary artery was connected to the left anterior descending artery in all 1 9 patients. All patients were moved to the hemodynamic ward immediately aft er surgery in 7 cases and before 48 h in the rest, 24 angioplasties were pe rformed. A mean of 2.6 vessels per patient were revascularizated and revasc ularization was complete in 15 patients (79%). Results. One patient had perioperative myocardial infarction. There was no hospital mortality. Length of stay in the intensive care unit was 44 h (IQR = 49) and global postoperative stay was 8 days (IQR = 3.5). In the postoperative angiographic study, before the angioplasty, 95% of mam mary arteries (CI 95% 74-100%) and 100% of saphenous grafts (CI 95% 59-100% ) were patent. Conclusions, Combined revascularization allows almost complete revasculariz ation, avoiding complications of cardiopulmonary bypass and minimizing surg ical aggression. At the same time, it secures the graft of internal mammary artery to left anterior descending artery.