Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study

Objective-To expand the benefits of the minimally invasive direct coronary artery bypass (MIDCAB) concept to patients with multivessel disease, a hybr id procedure combining surgical revascularisation of the left anterior desc ending artery with interventional procedures for additional coronary lesion s has recently been introduced. Preliminary results in patients undergoing this hybrid procedure are presented. Design and patients-Since December 1996, 35 patients (29 male, 6 female, me an (SD) age 56.7 (17) years) underwent a hybrid revascularisation performed as a primary MIDCAB procedure for grafting of the left anterior descending artery with the left internal mammary artery, followed by staged angioplas ty and stenting of additional coronary lesions. Results-After MIDCAB grafting the postoperative course was uneventful in al l patients. Coronary reangiography after a median of seven days revealed pa tent and functioning left internal mammary artery grafts in all patients. A pplying subsequent percutaneous transluminal coronary angioplasty and occas ional stenting (n = 14), a total of 47 lesions were treated successfully. P rocedure related complications did not occur. All patients remained free fr om angina and no stress ECG changes were recorded. Conclusions-The preliminary results of this hybrid approach to myocardial r evascularisation suggest that this is a safe and effective procedure for co mplete revascularisation in selected patients with multivessel disease. Eld erly and reoperative patients with significant comorbidity may benefit espe cially from such hybrid procedures by avoiding cardiopulmonary bypass and m id sternotomy.