Hybrid Off-pump Coronary Artery Bypass Combined with Percutaneous Coronary Intervention: Indications and Early Results

Hwang, Ho Young; Kim, Jin Hyun; Cho, Kwang Ree; Kim, Ki Bong

Abstract

BACKGROUND: The possibility of incomplete revascularization and development of flow competition after revascularization of the borderline lesion made the hybrid strategy as an option for complete revascularization. MATERIAL AND METHOD: From January 1998 to July 2004, 25 (3.2%) patients underwent hybrid revascularization among 782 total OPCAB procedures. Clinical results and angiographic patencies were evalulated. Percutaneous coronary intervention (PCI) was performed before CABG in 8 patients and after CABG in 17 patients. RESULT: The causes of PCIs before CABG were to achieve complete revascularization with minimally invasive surgery (n=7) and emergent PCI for culprit lesion (n=1). The indications of PCIs after CABG were high possibility of flow competition in the borderline lesion of right coronary artery territory (n=8), diffuse atheromatous lesion preventing anastomosis of graft (n=5), severe calcified ascending aorta with no more arterial graft available (n=3), and intramyocardial coronary lesion (n=1). Mean number of distal anastomoses was 2.3+/-1.0. Mean number of lesions treated by PCI was 1.2+/-0.4. There was no operative or procedure-related mortality. PCI-related complication was periprocedural myocardial infarction in one patient, and complications related to CABG were transient atrial fibrillation (n=5), perioperative myocardial infarction (n=1), and transient renal dysfunction (n=1). Early postoperative coronary angiography (1.8+/-1.6 days) revealed 100% patency rate of grafts (57/57). The stenosis occurred in one patient performed PCI before CABG, which was successfully treated with re-ballooning. During midterm follow-up (mean; 25+/-26 months), 1 patient died of congestive heart failure. All survivors (n=24) accomplished follow-up coronary angiographics, which showed all grafts (56/57) were patent except one string sign. In-stent restenosis was developed in 2 patients who received bare metal stents.
CONCLUSION
In selected patients, complete revascularization was achieved with low risk by taking the hybrid strategy.