title: [Hybrid revascularization].
abstract: OBJECTIVE
  To evaluate our initial experience in the combination of two less invasive procedures for myocardial revascularization, coronary artery bypass grafting without cardiopulmonary bypass and immediate posterior angioplasty, on untreated lesions (hybrid revascularization) as an alternative treatment to conventional surgery in selected patients.
  
  
  METHODS
  From october 1996 to September 1998, 19 patients received hybrid revascularization. The mean age was 64 (47-76). Two patients underwent 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 factors for cardiopulmonary bypass and two or more vessel disease. The internal mammary artery was connected to the left anterior descending artery in all 19 patients. All patients were moved to the hemodynamic ward immediately after surgery in 7 cases and before 48 h in the rest, 24 angioplasties were performed. A mean of 2.6 vessels per patient were revascularized and revascularization 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 mammary arteries (CI 95% 74-100%) and 100% of saphenous grafts (CI 95% 59-100%) were patent.
  
  
  CONCLUSIONS
  Combined revascularization allows almost complete revascularization, avoiding complications of cardiopulmonary bypass and minimizing surgical aggression. At the same time, it secures the graft of internal mammary artery to left anterior descending artery.
authors.affiliation: Servicio de Cirugía Cardíaca, Hospital 12 de Octubre, Madrid.
authors.forename: J E
authors.initials: JE
authors.lastname: Rodríguez Hernández
authors.forename: M J
authors.initials: MJ
authors.lastname: López Gude
authors.forename: J J
authors.initials: JJ
authors.lastname: Rufilanchas Sánchez
authors.forename: L C
authors.initials: LC
authors.lastname: Maroto Castellanos
authors.forename: A A
authors.initials: AA
authors.lastname: González-Trevilla
authors.forename: J
authors.initials: J
authors.lastname: Tascón Pérez
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D003327:Coronary Disease / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000706:statistics & numerical data; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods / Q000706:statistics & numerical data; D012307:Risk Factors