title: Simultaneous integrated coronary artery revascularization with long-term angiographic follow-up.
abstract: OBJECTIVE
  Traditionally integrated coronary artery revascularization has been described as a 2-stage procedure. We evaluated the safety and feasibility of 1-stage, simultaneous, hybrid, robotically assisted coronary artery bypass grafting surgery and percutaneous coronary intervention.
  
  
  METHODS
  Fifty-eight patients underwent simultaneous, integrated coronary artery revascularization in an operating theater equipped with angiographic equipment. Forty-five patients were men. The mean age was 59 years. All internal thoracic arteries were harvested with robotic assistance. All anastomoses were manually constructed through a small anterior non-rib-spreading incision without cardiopulmonary bypass on the beating heart. Immediately after and within the same operative suite, both angiographic confirmation of graft patency and percutaneous coronary intervention were performed. In 52 patients therapeutic anticoagulation was achieved with the direct thrombin inhibitor bivalirudin.
  
  
  RESULTS
  There were no deaths or wound infections. There was 1 perioperative myocardial infarction. One patient had a stroke, and 3 patients required re-exploration for bleeding. The median lengths of intensive care and hospital stay were 1 and 4 days, respectively. All patients were alive and symptom free at follow-up (mean, 20.2 months; range, 1.1-40.8 months). Long-term angiographic follow-up in 54 patients showed 49 (91%) patent grafts (mean, 9.0 months; range, 4.3-40.8 months). There were 7 in-stent restenoses and 2 occluded stents.
  
  
  CONCLUSIONS
  For multivessel coronary artery disease, simultaneous integrated coronary artery revascularization with bivalirudin is safe and feasible. This approach enables complete multivessel revascularization with decreased surgical trauma and postoperative morbidity. Further studies are necessary to better determine patient selection and long-term outcomes.
authors.affiliation: Department of Surgery, University of Western Ontario, London Health Sciences Centre, University Hospital, Ivey Cardiac Centre, London, Ontario, Canada. bob.kiaii@lhsc.on.ca
authors.forename: Bob
authors.initials: B
authors.lastname: Kiaii
authors.forename: R Scott
authors.initials: RS
authors.lastname: McClure
authors.forename: Peter
authors.initials: P
authors.lastname: Stewart
authors.forename: Reiza
authors.initials: R
authors.lastname: Rayman
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Swinamer
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Suematsu
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fox
authors.forename: Jennifer
authors.initials: J
authors.lastname: Higgins
authors.forename: Caroline
authors.initials: C
authors.lastname: Albion
authors.forename: William J
authors.initials: WJ
authors.lastname: Kostuk
authors.forename: David
authors.initials: D
authors.lastname: Almond
authors.forename: Kumar
authors.initials: K
authors.lastname: Sridhar
authors.forename: Patrick
authors.initials: P
authors.lastname: Teefy
authors.forename: George
authors.initials: G
authors.lastname: Jablonsky
authors.forename: Pantelis
authors.initials: P
authors.lastname: Diamantouros
authors.forename: Wojciech B
authors.initials: WB
authors.lastname: Dobkowski
authors.forename: Philip
authors.initials: P
authors.lastname: Jones
authors.forename: Daniel
authors.initials: D
authors.lastname: Bainbridge
authors.forename: Ivan
authors.initials: I
authors.lastname: Iglesias
authors.forename: John
authors.initials: J
authors.lastname: Murkin
authors.forename: Davy
authors.initials: D
authors.lastname: Cheng
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Novick
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods*; D012371:Robotics; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants