title: Single-stage hybrid coronary revascularization with long-term follow-up.
abstract: OBJECTIVE
  Hybrid coronary revascularization, performing a left internal thoracic artery (LITA) to left anterior descending (LAD) bypass followed by percutaneous coronary intervention (PCI) in a non-LAD coronary artery lesion, represents an evolving revascularization strategy. It utilizes the survival benefit of the LITA-to-LAD bypass, while providing complete revascularization with PCI to a non-critical vessel to decrease procedural morbidity. However, quantitative patency results and clinical outcomes remain understudied. The objective of this study was to assess clinical follow-up and graft and stent patency at 6 months and 5 years in a single-stage hybrid revascularization population.
  
  
  METHODS
  From 2004 to 2012, a total of 96 patients (64 ± 12 years; 70 males and 26 females) consented to robotic-assisted LITA harvesting and a small left anterior thoracotomy for off-pump coronary artery bypass anastomosis onto the LAD. This was followed immediately by PCI in a non-LAD vessel in the same fluoroscopy-equipped hybrid operating room. Patients underwent a yearly clinical follow-up and a protocol-directed assessment of graft patency via a coronary angiogram at 6 months and cardiac computed tomography (CT) angiography with single-photon emission computed tomography myocardial perfusion scintigraphy (MPS) at 5 years.
  
  
  RESULTS
  Successful single-stage hybrid revascularization occurred in 94 of the 96 patients (2 patients required intraoperative conversion to conventional coronary bypass). Six-month protocol coronary angiogram follow-up has been performed in 85 patients. Fitzgibbon Grade A or B LITA-to-LAD patency at 6-month follow-up was 94% in those studied. A total of 105 stents were deployed (89 drug-eluting stents (DES) and 16 bare metal), and at 6-month follow-up in 85 patients, 79 stents were widely patent; 8 had in-stent restenosis, and 2 were completely occluded. To date, 19 patients have undergone 5-year coronary CT angiography and MPS. The LITA-to-LAD anastomosis was patent in 17 of the 19 patients. Of the 19 lesions in which PCI was performed, 17 were widely patent, while 2 circumflex DES were occluded. Five-year clinical outcome demonstrated 91% survival, 94% freedom from angina and 87% freedom from any form of coronary revascularization.
  
  
  CONCLUSIONS
  A single-stage hybrid revascularization strategy appears to have acceptable 6-month and angiographic patency results for both LITA-LAD grafts and PCI interventions. Survival, freedom from angina and freedom from revascularization also appear favourable at the 5-year clinical follow-up.
authors: Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, ON, Canada.
authors: Corey
authors: C
authors: Adams
authors: Daniel J P
authors: DJ
authors: Burns
authors: Michael W A
authors: MW
authors: Chu
authors: Philip M
authors: PM
authors: Jones
authors: Kumar
authors: K
authors: Shridar
authors: Patrick
authors: P
authors: Teefy
authors: William J
authors: WJ
authors: Kostuk
authors: Wojciech B
authors: WB
authors: Dobkowski
authors: Jonathan
authors: J
authors: Romsa
authors: Bob
authors: B
authors: Kiaii
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality*; D012371:Robotics; D016896:Treatment Outcome; D014654:Vascular Patency
keywords: Coronary disease; Minimally invasive surgery