Early and Mid-term Follow-up Outcomes of“One-stop” Hybrid Coronary Revascularization for Patients with Multivessel Coronary Artery Disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Haoran , HU Shengshou , XU Bo

Department of Cardiovascular Surgery, Fu Wai Hospital, Chinese Academy of Medical Science &;
Peking Union Medical University, Beijing 100037, P. R. China;

Corresponding author：

Keywords：

Coronary artery disease; ?“One-stop” hybrid coronary revascularization; ?Coronary artery bypass grafting; ?Percutaneous coronary intervention

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Abstract： Objectives To evaluate the early and mid-term follow-up outcomes of “one-stop” hybrid coronary revascularization strategy for patients with multivessel coronary artery disease. Methods From June 2007 to December 2009, 104 consecutive patients underwent “one-stop”hybrid coronary revascularization in Fu Wai Hospital. There were 93 male patients and 11 female patients with mean age of （61.8±10.2）years（ranging from 35 to 81 years）. All the patients had multivessel coronary artery disease including left anterior descending （LAD）coronary artery stenosis, and underwent “one-stop”hybrid coronary revascularization. “One-stop”hybrid procedure was first performed through a lower partial sternotomy at the second left intercostal space. The distal anastomosis of in situ left internal mammary artery （LIMA）to LAD graft was completed. Angiography was performed immediately to confirm patency of the LIMA graft after closure of the thorax. A 300 mg loading dose of clopidogrel was administered through a nasogastric tube after confirmation of LIMA graft patency. Intravenous unfractionated heparin was administered to obtain an activated clotting time of greater than 250 s. Then percutaneous coronary intervention（PCI）was performed on the non-LAD lesions. Results All the patients underwent“one-stop”hybrid coronary revascularization including grafted LIMA to LAD，and one hundred and ninety one drug eluting stents and three bare metal stents were used for other non-LAD lesions. No death event occurred during surgery and in hospital. All the patients were followed up for a mean duration of 1.5 years. There was no myocardial infarction, neurologic event or death occurred during follow-up except one patient with stent stenosis who was treated by PCI. Conclusion “One-stop” hybrid coronary revascularization is a feasible and safe alternative for patients with multivessel coronary artery disease.

Citation： WANG Haoran,HU Shengshou,XU Bo,et al .. Early and Mid-term Follow-up Outcomes of“One-stop” Hybrid Coronary Revascularization for Patients with Multivessel Coronary Artery Disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 232-234. doi: Copy

1.	Circulation， 2004， 13 （11）：54-55.
2.	J Med， 2008， 358 （4）：331-341.
3.	Angelini GD， Wilde P， Salerno TA， et al. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet，1996， 347 （9003）：757-758.
4.	Amodeo VJ， Donias HW， Dancona G， et al. The hybrid approach to coronary artery revascularization：minimally invasive direct coronary artery bypass　with percutaneous coronary intervention. Angiology， 2002， 53 （6）：665-669.
5.	Wittwer T， Cremer J， Boonstra P， et al. Myocardial“hybrid” revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty:preliminary results of a multicentre study. Heart， 2000， 83 （1）：58-63.
6.	Bonaros N， Schachner T， Wiedemann D， et al. Closed chest hybrid coronary revascularization for multivessel disease - current concepts and　techniques from a two-center experience. Eur J Cardiothorac Surg， 2011， 40 （4）：783-787.
7.	Bravata DM，Gienger AL， Mcdonald KM， et al. Systematic review：the comparative effectiveness of percutaneous coronary interventions and coronary　artery bypass graft surgery. Ann Intern Med， 2007， 147 （10）：703-716.
8.	BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol， 2007， 49 （15）：1600-1606.
9.	Kim KB， Cho KR， Jeong DS. Midterm angiographic follow-up after off-pump coronary artery bypass：serial comparison using early， 1-year， and 5-year postoperative angiograms. J Thorac Cardiovasc Surg， 2008， 135 （2）：300-307.
10.	Hayward PA， Buxton BF. Contemporary coronary graft patency：5-year observational data from a randomized trial of conduits. Ann Thorac Surg， 2007， 84 （3）：795-799.
11.	Tatoulis J， Buxton BF， Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg， 2004， 77 （1）：93-101.
12.	Cameron A， Davis KB， Green G， et al. Coronary bypass surgery with internal-thoracic-artery grafts―effects on survival over a 15-year period. N Engl J Med， 1996， 334 （4）：216-219.
13.	Puskas JD， Williams WH， Mahoney EM， et al. Off-pump vs conventional coronary artery bypass grafting：early and 1-year graft patency， cost， and quality-of-life outcomes：a randomized trial. JAMA， 2004， 291 （15）：1841-1849.
14.	Kim KB， Cho KR， Jeong DS. Midterm angiographic follow-up after off-pump coronary artery bypass：serial comparison using early， 1-year， and 5-year postoperative angiograms. J Thorac Cardiovasc Surg， 2008， 135 （2）：300-307.
15.	Sawhney N， Moses JW， Leon MB. Treatment of left anterior descending coronary artery disease with sirolimus-eluting stents.
16.	Hannan EL， Wu C， Walford G， et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl.
17.	Byrne JG， Leacche M， Vaughan DE， et al. Hybrid cardiovascular procedures. JACC Cardiovasc Interv， 2008， 1 （5）：459-468.
18.	Shirani S， Boroumand MA， Abbasi SH， et al. Preoperative carotid artery screening in patients undergoing coronary artery bypass graft surgery. Arch Med Res， 2006， 37 （8）：987-990.
19.	Lund C， Hol PK， Lundblad R， et al. Comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg， 2003， 76 （3）：765-770.

1. Circulation， 2004， 13 （11）：54-55.
2. J Med， 2008， 358 （4）：331-341.
3. 　Angelini GD， Wilde P， Salerno TA， et al. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet，1996， 347 （9003）：757-758.
4. 　Amodeo VJ， Donias HW， Dancona G， et al. The hybrid approach to coronary artery revascularization：minimally invasive direct coronary artery bypass　with percutaneous coronary intervention. Angiology， 2002， 53 （6）：665-669.
5. 　Wittwer T， Cremer J， Boonstra P， et al. Myocardial“hybrid” revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty:preliminary results of a multicentre study. Heart， 2000， 83 （1）：58-63.
6. 　Bonaros N， Schachner T， Wiedemann D， et al. Closed chest hybrid coronary revascularization for multivessel disease - current concepts and　techniques from a two-center experience. Eur J Cardiothorac Surg， 2011， 40 （4）：783-787.
7. 　Bravata DM，Gienger AL， Mcdonald KM， et al. Systematic review：the comparative effectiveness of percutaneous coronary interventions and coronary　artery bypass graft surgery. Ann Intern Med， 2007， 147 （10）：703-716.
8. 　BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol， 2007， 49 （15）：1600-1606.
9. 　Kim KB， Cho KR， Jeong DS. Midterm angiographic follow-up after off-pump coronary artery bypass：serial comparison using early， 1-year， and 5-year postoperative angiograms. J Thorac Cardiovasc Surg， 2008， 135 （2）：300-307.
10. 　Hayward PA， Buxton BF. Contemporary coronary graft patency：5-year observational data from a randomized trial of conduits. Ann Thorac Surg， 2007， 84 （3）：795-799.
11. 　Tatoulis J， Buxton BF， Fuller JA. Patencies of 2127 arterial to coronary conduits over 15 years. Ann Thorac Surg， 2004， 77 （1）：93-101.
12. 　Cameron A， Davis KB， Green G， et al. Coronary bypass surgery with internal-thoracic-artery grafts―effects on survival over a 15-year period. N Engl J Med， 1996， 334 （4）：216-219.
13. 　Puskas JD， Williams WH， Mahoney EM， et al. Off-pump vs conventional coronary artery bypass grafting：early and 1-year graft patency， cost， and quality-of-life outcomes：a randomized trial. JAMA， 2004， 291 （15）：1841-1849.
14. 　Kim KB， Cho KR， Jeong DS. Midterm angiographic follow-up after off-pump coronary artery bypass：serial comparison using early， 1-year， and 5-year postoperative angiograms. J Thorac Cardiovasc Surg， 2008， 135 （2）：300-307.
15. 　Sawhney N， Moses JW， Leon MB. Treatment of left anterior descending coronary artery disease with sirolimus-eluting stents.
16. 　Hannan EL， Wu C， Walford G， et al. Drug-eluting stents vs. coronary-artery bypass grafting in multivessel coronary disease. N Engl.
17. 　Byrne JG， Leacche M， Vaughan DE， et al. Hybrid cardiovascular procedures. JACC Cardiovasc Interv， 2008， 1 （5）：459-468.
18. 　Shirani S， Boroumand MA， Abbasi SH， et al. Preoperative carotid artery screening in patients undergoing coronary artery bypass graft surgery. Arch Med Res， 2006， 37 （8）：987-990.
19. 　Lund C， Hol PK， Lundblad R， et al. Comparison of cerebral embolization during off-pump and on-pump coronary artery bypass surgery. Ann Thorac Surg， 2003， 76 （3）：765-770.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early and Mid-term Follow-up Outcomes of“One-stop” Hybrid Coronary Revascularization for Patients with Multivessel Coronary Artery Disease

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