title: Minimally invasive hybrid coronary artery revascularization.
abstract: BACKGROUND
  Here we report the short- and long-term results of a minimally invasive hybrid approach in 117 patients.
  
  
  METHODS
  From 1996 to 2007, revascularization of the left anterior descending artery was performed in 1,696 patients by minimally invasive direct coronary artery bypass grafting (MIDCAB), in 89 patients by beating-heart totally endoscopic coronary artery bypass grafting (TECAB) and in 30 patients by arrested-heart TECAB. Of these patients, 117 were scheduled for a hybrid procedure. Revascularization of the left anterior descending artery was performed by either MIDCAB (107 patients), beating-heart TECAB (8 patients) or arrested-heart TECAB (2 patients). Percutaneous coronary intervention of vessels other than the left anterior descending artery was performed 4 to 6 weeks preoperatively (53 cases), intraoperatively (5 cases), or 2 to 45 days postoperatively (59 cases). Demographic data, perioperative outcome, and annual follow-up were obtained from all patients.
  
  
  RESULTS
  Minimally invasive bypass and stenting could be completed in all patients. Two high-risk patients (1.9%) died postoperatively. Follow-up of all patients adds up to 208 patient-years. Eight patients died during follow-up. Kaplan-Meier survival was 92.5% (95% confidence interval [CI]: 86.5% to 98.4%) at 1 year and 84.8% (95% CI: 73.5% to 94.9%) at 5 years. Follow-up angiogram of symptomatic patients showed 1 bypass occlusion and 5 in-stent restenosis with need for reintervention. Freedom from major adverse cardiac and cerebral events (including reintervention) and angina was 85.5% (95% CI: 76.9% to 94.1%) at 1 year and 75.5% (95% CI: 62.7% to 87.3%) at 5 years.
  
  
  CONCLUSIONS
  Minimally invasive hybrid coronary revascularization is a safe approach with good long-term results. It should be performed in selected patients at centers with considerable experience in minimally invasive bypass surgery and requires close cooperation between cardiologists and surgeons.
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
authors.forename: David M
authors.initials: DM
authors.lastname: Holzhey
authors.forename: Stephan
authors.initials: S
authors.lastname: Jacobs
authors.forename: Michael
authors.initials: M
authors.lastname: Mochalski
authors.forename: Denis
authors.initials: D
authors.lastname: Merk
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000401:mortality; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D009204:Myocardial Revascularization / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015607:Stents; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome