New Way to Go: Hybrid Coronary Revascularization (CABG)

Abstract

Background: This is a Minimal invasive case series of coronary revascularization in selective group of patients treated with one stop Hybrid approach. Objective: Treating coronary heart disease is challenging and the option of revascularization is changing over time. We sought the idea to mix, best of both intervention and surgery. Methods: Patients were selected according to angiogram result with significant LAD lesion and secondary LCx and RCA lesion. Patient with severe obesity and severe pulmonary hypertension were excluded. Peripheral Fem-fem cannulation was carried out. 5-7cm submammary left-anterior incision was fashioned. IMA harvested in manual fashion under direct vision. Medtronic Octopus-Novo retractor was used. Progressive revascularization was performed in a proximal first-distal second-LIMA to LAD last sequence. Controlled angiography was carried out in the same session followed by PCI to the non-LAD lesion. Results: Total 18 cases were done in between October 2014 to June 2015. Average ejection fraction was 58.22%. Thoracotomy wound length 5.50±1.25cm. All patients’ recovery was uneventful. We had one case of conversion due to VF as a result of frustraneous stenting attempts of a bifurcational stenosis. Average length of hospital stays (LOS) 5±1 days. One patient needed LAD endarterectomy. On table IMA-graphy done, showed all patent vessel. Nil 30 days in hospital mortality. One patient needed intra-aortic balloon pump support and interval PCI. Conclusions: Stand-alone MIS coronary revascularization in McGinn technique and/or Hybrid completion presents powerful tools for coronary revascularization in the modern era in steep learning curve.