title: Coronary hybrid revascularization from January 1997 to January 2001: a clinical follow-up.
abstract: BACKGROUND
  Hybrid revascularization (HyR), combining minimally invasive left internal mammary artery (LIMA) bypass grafting to the left anterior descending coronary artery (LAD) and catheter interventional treatment of the remaining coronary lesions, avoids the disadvantages associated with cardiopulmonary bypass (CPB). We investigated the clinical follow-up of 57 patients with multivessel disease undergoing this procedure in the last 4 years.
  
  
  METHODS
  Between January 1997 and January 2001, 57 consecutive patients (41 men and 16 women, aged 65.7 +/- 7.9 years) with coronary artery disease (two-vessel, n = 34; three-vessel, n = 23) were treated with off-pump LIMA-to-LAD bypass combined with balloon angioplasty and stenting of the remaining significantly obstructed (> 50%) coronary vessels. Clinical follow-up data included a early postoperative and a 6-month control angiography and a patient interview in January 2001.
  
  
  RESULTS
  All patients underwent LIMA-to-LAD bypass-grafting and balloon angioplasty in 72 coronary lesions without procedural-related complications. However, one early LIMA bypass occlusion was documented during coronary angiography. Postoperatively no deterioration of preexistent organ dysfunction was observed in any patient. The mean follow-up was 100.7 +/- 37.9 weeks in 55 of 57 patients (97%). Control angiography 6 months after HyR (n = 34) revealed a patent LIMA bypass in 33 patients and 8 in-stent restenoses (> 50%) in the coronary arteries that were treated interventionally by re-PTCA (n = 6) or by conventional CABG (n = 1). In 1 patient medical treatment resulted in significant reduction of angina so no further intervention was considered necessary. After HyR 1 patient died 18 months later of an intracerebral hemorrhage. All other patients are alive and doing well.
  
  
  CONCLUSIONS
  Our results indicate that in selected patients with multivessel disease including left main stem stenosis HyR is an effective and secure procedure with excellent early and good midterm results. Especially elderly patients with severe concomitant diseases appear to benefit from this approach by avoiding CPB.
authors.affiliation: Heart Center Hamburg, Albertinen-Krankenhaus, Department of Cardiac Surgery, Hamburg-Othmarschen, Germany. friedrich-christian.riess@albertinen.de
authors.forename: Friedrich-Christian
authors.initials: FC
authors.lastname: Riess
authors.forename: Ralf
authors.initials: R
authors.lastname: Bader
authors.forename: Peter
authors.initials: P
authors.lastname: Kremer
authors.forename: Clemens
authors.initials: C
authors.lastname: Kühn
authors.forename: Joachim
authors.initials: J
authors.lastname: Kormann
authors.forename: Detlef
authors.initials: D
authors.lastname: Mathey
authors.forename: Sina
authors.initials: S
authors.lastname: Moshar
authors.forename: Thilo
authors.initials: T
authors.lastname: Tuebler
authors.forename: Niels
authors.initials: N
authors.lastname: Bleese
authors.forename: Joachim
authors.initials: J
authors.lastname: Schofer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D013997:Time Factors