title: Hybrid coronary revascularization in high-risk patients.
abstract: From January 2002 through June 2004, 17 patients (2% of all coronary cases) were treated with off-pump coronary artery bypass grafting combined with percutaneous coronary intervention. There were 13 men and 4 women, whose ages ranged from 54 to 78 years (mean, 63.1 +/- 20.9 yr). Preoperative angiography revealed 2-vessel coronary artery disease in 12 patients and 3-vessel disease in the remaining 5 patients. In all patients, extensive lesions (>50%) in the circumflex and right coronary arteries were treated first with a percutaneous intervention, followed by beating-heart coronary artery bypass grafting within 3 hours to treat the remaining obstructed vessels. Coronary angiography was performed 12 months after the operation to evaluate the effectiveness of the procedure. Procedure-related complications did not occur, and there was no in-hospital death. All patients underwent a successful left internal mammary artery-left anterior descending artery anastomosis with the exception of 1 patient, in whom we used a saphenous vein because of previous chest radiotherapy. The postoperative courses were uneventful, and no deterioration of preoperative organ dysfunction was noticed in any patient. There was no cardiac-related death or myocardial infarction. In follow-up angiography, all left internal mammary artery-left anterior descending artery anastomoses were patent. Three patients with restenosis were treated medically, which resulted in substantial reduction of angina. Hybrid coronary revascularization enables complete revascularization and may be an alternative method of treating selected patients who have concomitant disease.
authors.affiliation: Department of Cardiovascular Surgery, GATA Haydarpasa Training Hospital, 81080 Istanbul, Turkey. usmelih@yahoo.com
authors.forename: Melih Hulusi
authors.initials: MH
authors.lastname: Us
authors.forename: Murat
authors.initials: M
authors.lastname: Basaran
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yilmaz
authors.forename: Bengi
authors.initials: B
authors.lastname: Yaymaci
authors.forename: Eralp
authors.initials: E
authors.lastname: Ulusoy
authors.forename: Soner
authors.initials: S
authors.lastname: Sanioglu
authors.forename: Cihan
authors.initials: C
authors.lastname: Ozbek
authors.forename: Yucesin
authors.initials: Y
authors.lastname: Arslan
authors.forename: Sibel
authors.initials: S
authors.lastname: Pocan
authors.forename: Ahmet Turan
authors.initials: AT
authors.lastname: Yilmaz
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D003331:Coronary Vessels / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D011183:Postoperative Complications; D012307:Risk Factors; D013997:Time Factors