title: Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study.
abstract: OBJECTIVE
  To expand the benefits of the minimally invasive direct coronary artery bypass (MIDCAB) concept to patients with multivessel disease, a hybrid procedure combining surgical revascularisation of the left anterior descending artery with interventional procedures for additional coronary lesions has recently been introduced. Preliminary results in patients undergoing this hybrid procedure are presented.
  
  
  METHODS
  Since December 1996, 35 patients (29 male, 6 female, mean (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 angioplasty and stenting of additional coronary lesions.
  
  
  RESULTS
  After MIDCAB grafting the postoperative course was uneventful in all patients. Coronary reangiography after a median of seven days revealed patent and functioning left internal mammary artery grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty and occasional stenting (n = 14), a total of 47 lesions were treated successfully. Procedure related complications did not occur. All patients remained free from angina and no stress ECG changes were recorded.
  
  
  CONCLUSIONS
  The preliminary results of this hybrid approach to myocardial revascularisation suggest that this is a safe and effective procedure for complete revascularisation in selected patients with multivessel disease. Elderly and reoperative patients with significant comorbidity may benefit especially from such hybrid procedures by avoiding cardiopulmonary bypass and mid sternotomy.
authors.affiliation: Department of Cardiothoracic Surgery, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany. Th.Wittwer-MD@t-online.de
authors.forename: T
authors.initials: T
authors.lastname: Wittwer
authors.forename: J
authors.initials: J
authors.lastname: Cremer
authors.forename: P
authors.initials: P
authors.lastname: Boonstra
authors.forename: J
authors.initials: J
authors.lastname: Grandjean
authors.forename: M
authors.initials: M
authors.lastname: Mariani
authors.forename: A
authors.initials: A
authors.lastname: Mügge
authors.forename: H
authors.initials: H
authors.lastname: Drexler
authors.forename: P
authors.initials: P
authors.lastname: den Heijer
authors.forename: E R
authors.initials: ER
authors.lastname: Leitner
authors.forename: A
authors.initials: A
authors.lastname: Hepp
authors.forename: M
authors.initials: M
authors.lastname: Wehr
authors.forename: A
authors.initials: A
authors.lastname: Haverich
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D017023:Coronary Angiography; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009204:Myocardial Revascularization / Q000379:methods*; D015607:Stents