Simultaneous hybrid coronary revascularization using totally endoscopic left internal mammary artery bypass grafting and placement of rapamycin eluting stents in the same interventional session. The COMBINATION pilot study.
OBJECTIVE
Hybrid coronary revascularization procedures apply minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for treatment of multivessel coronary artery disease. For logistic reasons simultaneous procedures would be desirable. In a pilot study the feasibility of simultaneous robotic totally endoscopic CABG and PCI using drug eluting stents was assessed.


METHODS
Five patients were scheduled to undergo simultaneous combined coronary intervention. A left internal mammary artery bypass graft was placed to the left anterior descending artery (LAD) in a completely endoscopic fashion using the daVinci telemanipulation system. PCI was carried out in the surgical operating room with the GE OEC9800 mobile coronary angiography C-arm. Rapamycin coated Cypher stents were placed into stenotic non-LAD targets.


RESULTS
The procedure was feasible in 4 patients, one patient was converted to a double CABG operation. There were no significant postoperative clinical complications and patients were discharged from intensive care unit and the hospital after 19 (18-61) hours and 6 (5-7) days respectively. At 6 months postoperatively all patients are free from angina.


CONCLUSIONS
We conclude that simultaneous robotic totally endoscopic left internal mammary artery to LAD placement and PCI to non-LAD targets using drug eluting stents is feasible in one session.
Bonatti
Johannes
J
Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. johannes.o.bonatti@i-med.ac.at
Schachner
Thomas
T
Bonaros
Nikolaos
N
Jonetzko
Patrycja
P
Ohlinger
Armin
A
Ruetzler
Elisabeth
E
Kolbitsch
Christian
C
Feuchtner
Gudrun
G
Laufer
Guenther
G
Pachinger
Otmar
O
Friedrich
Guy
G
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D004724:Endoscopy; D005240:Feasibility Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods*; D008875:Middle Aged; D010865:Pilot Projects; D012371:Robotics; D020123:Sirolimus / Q000008:administration & dosage
D007166:Immunosuppressive Agents; D020123:Sirolimus