ABSTRACT 64

COMPLETE REVASCULARIZATION IN MULTI-VESSEL CORONARY ARTERY DISEASE USING A HYBRID APPROACH

Sven Beholz, Lars-Eric Pietsch, Wolfgang Konertz
Department for Cardiovascular Surgery, Charité, Humboldt-University, Berlin, Germany

Introduction: To avoid extracorporeal circulation a hybrid procedure with minimally invasive direct coronary artery bypass (MIDCAB) and percutaneous transluminal coronary angioplasty (PTCA) promises to be a reasonable alternative.

Material and Methods: 59 patients underwent the MIDCAB procedure combined with 72 PTCA´s and 14 stents in the remaining vessels resulting in complete revascularization. Preoperative risk factors included: renal insufficiency in 16, diabetes mellitus in 14, impaired left ventricular function in 11, pulmonary obstruction in 9, recent myocardial infarction in 9, cerebral vascular disease in 7 and reoperation in 2 patients.

Results: No patient suffered from myocardial infarction. Mean chest tube loss was 210 ml. Three patients were reexplored due to bleeding. All patients survived the procedure. There were no complications related to PTCA. Mean follow up was 26 months; 4 patients died. 8 patients were lost to follow-up. 47 patients were in CASS angina class 1 or 2 without any reinterventions.

Conclusions: Regarding the adverse effects of cardiopulmonary bypass on different organ systems a hybrid approach for complete revascularization is feasible with good midterm results.