McGinn and hybrid multi-vessel coronary revascularization: Looking for the future direction

Abstract

• Objectives Multivessel coronary revascularization is always a matter of interest and conflict. Use of internal mammary artery (IMA) still gold standard and the era of drug eluting stent (DES) is expanding. We took the effort to combine the benefit of both minimal invasive coronary bypass graft surgery (MIS CABG) and percutaneous coronary intervention (PCI) for non-left anterior descending artery (LAD) lesion.

• Material and Method We report a case series of multivessel revascularization with McGinn-multivessel MIS CABG with concomitant PCI with DES for non-LAD lesion. Total 5 cases done in between October 2014 to June 2015. Left main coronary artery disease patient are electively excluded. All LAD anastomoses done using IMA and obtuse marginal branches with long saphenous vein graft (SVG). All SVG harvested using minimal invasive endoscopic vein harvesting (EVH) technique. PCI to right coronary artery done with DES-Xience, Xpedition.

• Results Average ejection fraction 55.2%. Thoracotomy wound length 5.15±1.25cm. Average length of hospital stay (LOS) 5±1 days. One patient needed LAD endarterectomy. On table IMA-graphy done, showed all patent vessel. Nil conversion to conventional surgery. Nil 30 days in hospital mortality. One patient needed intra-aortic balloon pump (IABP) support and interval PCI.

• Conclusions and Learning Points MIS McGinn and Hybrid is a safe complete revascularization procedure. We seek to provide an overview of hybrid revascularization in the era of modern drug eluting stent technology. The Nambiar Technique is the future challenge.