ABSTRACT 48

LONGTERM RESULTS AFTER HYBRID REVASCULARIZATION

Ralf Bader, Joachim Schofer, Sina Moshar, Thilo Tuebler, Niels Bleese, Peter Kremer, Friedrich-Christian Riess
Heart Center Hamburg, Germany

Objective: We seek to assess longterm mortality and morbidity associated with the hybrid revascularization technique (HR), which combines operative and interventional catheter treatment by minimally invasive left internal mammary artery (LIMA) bypass grafting to the left anterior descending coronary artery (LAD) and PTCA/stenting of remaining coronary lesions.

Methods: Between 1/1997 until 10/2000 we performed HR in 57 patients (41 male, 16 female) with coronary multivessel disease whose stenoses seemed to be suitable for PTCA/stenting procedure, only LAD stenoses were not. Patients mean age was 65.7 ± 7.9 (46-86) years; LVEF was 64.9 ± 11.4%. All patients had a significant LAD stenosis (n=50) or occlusion (n=7); 34 patients suffered from a 2-vessel and 23 patients from a 3-vessel disease. Severe concomitant diseases were present in 25 cases. Minimally invasive LIMA-to-LAD bypass was performed by ministernotomy and midCOAST™ device (Aesculap, Tuttlingen, Germany). PTCA/stenting were performed 4.8 ± 0.8 days after surgery (n=53) and 22 (1-63) days prior to surgery (n=4). Angiographic controls were carried out 6 months after HR.

Results: In all 57 patients LIMA-to-LAD revascularization could be performed successfully and without intraoperative complications. No preexistent organ dysfunctions were observed to deteriorate. Early postoperative angiographic controls demonstrated the quality of anastomoses and LIMA-grafts to be exellent in 56 patients. One LIMA-graft showed to be occluded by dissection, but could be stented successfully. The additional coronary lesions, 72 in total, could be revascularized successfully by PTCA/stenting. Late angiographic controls about 6 months after HR also showed patent LIMA-bypasses in all cases except the one that had been stented. Except two, all other coronary stenoses treated by PTCA/stenting showed to be patent at this time. However, 10 of 57 patients developed an > 50% in-stent restenosis, of which 7 had been redilated successfully.

Conclusions: Our data demonstrate that HR is a secure and effective procedure with excellent early results. However, thus far, this approach is limited by the restenosis rate demonstrated in midterm results after balloon angioplasty. Brachy-therapy or newer inter-ventional techniques may lower the incidence of restenosis-risk.