"Hybrid" percutaneous and surgical coronary revascularization: selection criteria from a single-center experience

BACKGROUND: The association of minimally invasive direct coronary artery bypass (MIDCAB) to percutaneous transluminal coronary angioplasty (PTCA) of large arteries with focal lesions can be an alternative therapeutic method for patients with multivessel coronary artery disease. We reviewed our experience regarding 42 patients treated at our Institute. METHODS: MIDCAB and PTCA of the circumflex or right coronary arteries > 3 mm were performed in 42 patients from September 1997 to December 1999. RESULTS: One patient died after MIDCAB in the operating room because of rupture of the left anterior descending anastomosis. Postoperative angiography confirmed patency of the internal mammary artery (IMA) graft in 92.3% of cases: 3 early IMA graft failures occurred. The success rate for PTCA was 98%: in 1 case the wire just would not cross a chronically and totally occluded right coronary artery. The in-hospital morbidity was 12.2%: 2 patients required urgent sternotomy respectively for cardiac tamponade and coronary artery bypass grafting on cardiopulmonary bypass. One patient developed atheroembolism after PTCA with recurrence of symptoms, progressive multiorgan failure and death. Two patients required PTCA on the IMA anastomosis because of early failure of the arterial graft. At a medium follow-up of 535 days, all 40 survivors are in Canadian Cardiovascular Society class I. CONCLUSIONS: Hybrid revascularization appears to be an effective treatment for selected patients with multivessel coronary artery disease. The immediate success seems related to the learning curve for MIDCAB