title: Hybrid coronary revascularization for the treatment of left main coronary stenosis: a feasibility study.
abstract: OBJECTIVE
  To determine the feasibility of a hybrid coronary revascularization (HCR) approach for the treatment of left main (LM) coronary artery stenosis.
  
  
  BACKGROUND
  The recommended therapy for significant LM stenosis is coronary artery bypass grafting (CABG). Percutaneous coronary intervention (PCI) of unprotected LM lesions is reserved for patients at high risk for complications with CABG. HCR in LM disease has not been studied.
  
  
  METHODS
  Twenty-two consecutive patients with LM stenosis >70% underwent staged HCR. Following a robotic or thoracoscopic-assisted minimally invasive left internal mammary artery (LIMA) to left anterior descending artery (LAD) coronary bypass, PCI of the LM, and non-LAD targets was performed after angiographic confirmation of LIMA patency. Intravascular ultrasound confirmed optimal stent deployment. Thirty-day adverse outcomes and long term follow up was obtained.
  
  
  RESULTS
  In the 22 patients with LM lesions, 6 were ostial, 5 mid, and 11 distal. LIMA patency was FitzGibbon A in all cases. LM stenting was successful in all patients with drug-eluting stents (DES) placed in 21 of 22 cases. Three patients underwent stent implantation in the right coronary artery. There were no 30-day major adverse cardiac or cerebrovascular events. At a mean of 38.8 ± 22 months postprocedure, 21 patients were alive without reintervention; one death occurred at 454 days.
  
  
  CONCLUSIONS
  HCR for LM coronary disease is a feasible alternative to CABG and unprotected LM PCI. This approach combines the long-term durability of a LIMA-LAD bypass with the less invasive option of PCI in non-LAD targets with DES.
authors.affiliation: Division of Cardiology, Andreas Gruentzig Cardiovascular Center of Emory University School of Medicine, Atlanta, Georgia, USA. srab@emory.edu
authors.forename: S Tanveer
authors.initials: ST
authors.lastname: Rab
authors.forename: John S
authors.initials: JS
authors.lastname: Douglas
authors.forename: Ellen
authors.initials: E
authors.lastname: Lyons
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.forename: Darpan
authors.initials: D
authors.lastname: Bansal
authors.forename: Michael E
authors.initials: ME
authors.lastname: Halkos
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Vassiliades
mesh_terms: D000368:Aged; D002561:Cerebrovascular Disorders / Q000209:etiology; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D054855:Drug-Eluting Stents; D005240:Feasibility Studies; D005260:Female; D005845:Georgia; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation; D011474:Prosthesis Design; D012371:Robotics; D012720:Severity of Illness Index; D013906:Thoracoscopy; D013997:Time Factors; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional