Single-stage hybrid coronary revascularization with long-term follow-up

被引:56
作者
Adams, Corey [1 ]
Burns, Daniel J. P. [1 ]
Chu, Michael W. A. [1 ]
Jones, Philip M. [2 ]
Shridar, Kumar [3 ]
Teefy, Patrick [3 ]
Kostuk, William J. [3 ]
Dobkowski, Wojciech B. [2 ]
Romsa, Jonathan [4 ]
Kiaii, Bob [1 ]
机构
[1] Univ Western Ontario, Dept Surg, Div Cardiac Surg, London Hlth Sci Ctr, London, ON N6A 3K7, Canada
[2] Univ Western Ontario, Dept Anesthesia & Perioperat Med, London Hlth Sci Ctr, London, ON, Canada
[3] Univ Western Ontario, Dept Med, Div Cardiol, London Hlth Sci Ctr, London, ON, Canada
[4] Univ Western Ontario, Dept Med Imaging, Div Nucl Med, London Hlth Sci Ctr, London, ON, Canada
关键词
Coronary disease; Minimally invasive surgery; ARTERY-BYPASS; OUTCOMES; PLACEMENT; SURGERY; DISEASE;
D O I
10.1093/ejcts/ezt390
中图分类号
R5 [内科学];
学科分类号
100201 [内科学];
摘要
OBJECTIVES: Hybrid coronary revascularization, performing a left internal thoracic artery (LITA) to left anterior descending (LAD) bypass followed by percutaneous coronary intervention (PCI) in a non-LAD coronary artery lesion, represents an evolving revascularization strategy. It utilizes the survival benefit of the LITA-to-LAD bypass, while providing complete revascularization with PCI to a non-critical vessel to decrease procedural morbidity. However, quantitative patency results and clinical outcomes remain understudied. The objective of this study was to assess clinical follow-up and graft and stent patency at 6 months and 5 years in a single-stage hybrid revascularization population. METHODS: From 2004 to 2012, a total of 96 patients (64 +/- 12 years; 70 males and 26 females) consented to robotic-assisted LITA harvesting and a small left anterior thoracotomy for off-pump coronary artery bypass anastomosis onto the LAD. This was followed immediately by PCI in a non-LAD vessel in the same fluoroscopy-equipped hybrid operating room. Patients underwent a yearly clinical follow-up and a protocol-directed assessment of graft patency via a coronary angiogram at 6 months and cardiac computed tomography (CT) angiography with single-photon emission computed tomography myocardial perfusion scintigraphy (MPS) at 5 years. RESULTS: Successful single-stage hybrid revascularization occurred in 94 of the 96 patients (2 patients required intraoperative conversion to conventional coronary bypass). Six-month protocol coronary angiogram follow-up has been performed in 85 patients. Fitzgibbon Grade A or B LITA-to-LAD patency at 6-month follow-up was 94% in those studied. A total of 105 stents were deployed (89 drug-eluting stents (DES) and 16 bare metal), and at 6-month follow-up in 85 patients, 79 stents were widely patent; 8 had in-stent restenosis, and 2 were completely occluded. To date, 19 patients have undergone 5-year coronary CT angiography and MPS. The LITA-to-LAD anastomosis was patent in 17 of the 19 patients. Of the 19 lesions in which PCI was performed, 17 were widely patent, while 2 circumflex DES were occluded. Five-year clinical outcome demonstrated 91% survival, 94% freedom from angina and 87% freedom from any form of coronary revascularization. CONCLUSIONS: A single-stage hybrid revascularization strategy appears to have acceptable 6-month and angiographic patency results for both LITA-LAD grafts and PCI interventions. Survival, freedom from angina and freedom from revascularization also appear favourable at the 5-year clinical follow-up.
引用
收藏
页码:438 / 443
页数:6
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