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.
ObjectiveTo evaluate the early and mid-term results of robot-assisted coronary artery bypass grafting (RACAB) in the treatment of multi-vessel coronary artery disease (MV-CAD). Methods Patients with MV-CAD who underwent RACAB from April 2018 to December 2021 in our hospital were included. Patients who underwent hybrid coronary revascularization (HCR) which combined RACAB with percutaneous coronary intervention were allocated to a HCR-RACAB group, and patients who underwent multi-vessel RACAB were allocated to a MV-RACAB group. Perioperative and follow-up data were collected and compared between the two groups. Results A total of 102 patients were included, including 81 males and 21 females with a mean age of 61.7±10.8 years. Two (2.0%) patients were transferred to conventional CABG due to sudden ventricular fibrillation and pleura adhesion. In the remaining 100 patients who underwent RACAB, 100 left internal mammary arteries (LIMA) and 46 right internal mammary arteries (RIMA) were harvested with a 100.0% success rate. Besides, all patients undergoing RACAB achieved LIMA/RIMA-left anterior descending branch reconstruction, with an average number of 2.5±0.6 target vessels revascularized by stent or graft. One patient had perioperative myocardial infarction with an outcome of death. The incidence of major perioperative adverse events was 1.0%. There was no perioperative stroke or re-sternotomy for hemostasis. The mean follow-up time was 28.2 months, with a follow-up rate of 99.0% and an overall major adverse cardiac and cerebrovascular event (MACCE) rate of 7.0%, including 3 all-cause deaths (3.0%), 2 strokes (2.0%) and 3 re-revascularizations (3.0%). The HCR-RACAB group had fewer red blood cell transfusion (P=0.030) and intraoperative blood loss (P=0.037) compared with the MV-RACAB group, and there was no statistical difference in the incidence of major perioperative adverse events or MACCE between the two groups during the follow-up period (P>0.05). ConclusionRACAB can be safely applied in the treatment of MV-CAD with good early and mid-term outcomes. High-quality harvesting of LIMA/RIMA and aortic no-touch technique are crucial to achieve these results.