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Ǵм Vol.24_No.2 Suppl. P.S36-48, Dec. 2007


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Hybrid Coronary Revascularization

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E-mail: sshan1007@ynu.ac.kr

December 30, 2007


Hybrid coronary revascularization combines left internal mammary artery (LIMA) to left anterior descending artery (LAD) grafting integrated with percutaneous coronary intervention (PCI) on stenoses in the non-LAD territories. Hybrid coronary revascularization offers multivessel revascularization with minimal morbidity in high risk patients. Usually hybrid coronary revascularization performs minimally invasive direct coronary artery bypass grafting (MIDCAB) without cardiopulmonary bypass. The concept is now 10 year old. This procedure has been developed from MIDCAB plus percutaneous transluminal coronary angioplasty (PTCA) to totally endoscopic coronary artery bypass grafting (TECAB) procedures plus PTCA and drug-eluting stenting (DES). The hybrid coronary revascularization procedure may be especially useful in complex LAD lesions, restenotic lesions in LAD, acute myocardial infarction in non-LAD territory, high-risk elderly patients with multiple comorbidities and patients with severe left ventricular systolic dysfunction who are not ideal candidates for conventional bypass surgery. Hybrid coronary revascularization results according to the literature are very attractive. LIMA patency rates were found to be in the 98% range and restenosis rates in the PCI part of the procedure are in a 12% range.16) The wider introduction of hybrid revascularization is limited chiefly by the high number of repeat interventions compared with off-pump coronary artery bypass grafting, which occurs because of the target vessel failure rate of percutaneous coronary intervention. Drug-eluting stents substantially decrease the reintervention rate. However, the future role of hybrid coronary revascularization is unclear in patients with multivessel coronary artery disease involving the LAD if comparable results may be attained with multivessel PCI.

Key Words: Hybrid coronary revascularization, Minimally invasive direct coronary artery bypass grafting, Percutaneous coronary intervention


1. Lee MS, Wilentz JR, Makkar RR, Singh V, Nero T, Swistel D, et al. Hybrid revascularization using percutaneous coronary intervention and robotically assisted minimally invasive direct coronary artery bypass surgery. J Invas Cardiol 2004;16:419-25.

2. Mariani MA, Boonstra PW, Grandjean JG, Peels JOJ, Monnink SHJ, den Heijr P, et al. Minimally invasive coronary bypass grafting versus coronary angioplasty for isolated type C stenosis of the anterior descending artery. J Thorac Cardiovasc Surg 1997;114:434-9.

3. Westaby S, Benetti F. Less invaseve coronary surgery: consensus from the Oxford meeting. Ann Thorac Surg 1996;62:924-31.

4. Drenth DJ, Winter JB, Veeger JGM, Monnink SHJ, van Boven AJ, Grandjean JG, et al. Minimally invasive coronary artery bypass grafting versus percutaneous transluminal coronary angioplasty with stenting in isolated high-grade stenosis of the proximal left anterior descending coronary artery: Six months angiographic and clinical follow-up of a prospective randomized study J Thorac Cardiovasc Surg 2002;124:130-35.

5. Moses JW, Leon MB, Popma JJ, et al. SIRIUS Investigators, 2003. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315-23.

6. Ovrum E, Tangen G, Am Holen E. 1997. Facing the era of minimally invasive coronary grafting: current results of conventional bypass grafting for single-vessel disease. Ann Thorac Surg 66:1076-81.

7. Loop FD, Lytle BW, Cosgrove DM. Influence on the internal mammary artery graft of 10 year survival and other cardiac events. N Engl J Med 1986;314:1-6.

8. Leimgruber PP, Roubin GS, Hollman J, et al. Restenosis after successful coronary angioplasty in patients with single-vessel disease. Circulation 1986;73:710-17.

9. Levine GN, Chodos AP, Loscalzo J. Restenosis following coronary angioplasty: Clinical presentations and therapeutic options. Clin Cardiol 1995;18:693-703.

10. Zenati M, Cohen HA, Griffith BP. Alternative approach to multivessel coronary disease with integrated coronary revascularization J Thorac Cardiovasc Surg 117(1999) 439-44.

11. Cisowski M, Morawski W, Drzewiecki J, Kruczak W, Toczek K, Bis J, et al. Intergrated minimally invasive direct coronary artery bypass grafting and angioplasty for coronary artery revascularization. European Journal of Cardio-thoracic Surgery 22 (2002): 261-5.

12. Murphy GJ., Bryan AJ, Angelini GD. Hybrid Coronary Revascularization in the Era of Drug-Eluting Stents. Ann Thoracic Surg 2004;78(5) :1861-7.

13. Nataf P, Lima L, Regan M, Benarim S, Ramadan R, Pavie A, et al. Thoracoscopic internal mammary artery harvesting: Technical considerations. Ann Tnorac Surg 1997;63:104-6.

14. Bonatti J, Schachner T, Bonaros N, Jonetzko P, Ohlinger A, Lockinger A, et al. Treatment of double vessel coronary artery disease by totally endoscopic bypass surgery and drug- eluting stent placement in one simultaneous hybrid session. The Heart Surgery Forum #2005-1136 8 (4), 2005 E284-6 [Epub July 2005]

15. Angelini GD, Wilde P, Salerno TA, Bosco G, Calafiore AM. 1996. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularization. Lancet 24: 757-8.

16. Freidrich GJ, Bonatti J. Hybrid coronary artery revascularization--review and update 2007. Heart Surg Forum. 2007;10(4):E292-6. Review.

17. Falk V, Diegeler A, Walther T, et al. 2000. Total endoscopic computer enhanced coronary artery bypass grafting. Eur J Cardiothorac Surg 17:38-45.

18. Riess FC, Schofer J, Kremer P, et al. Beating heart operations including hybrid revasculari- zation: Initial experiences. Ann Thorac Surg 1998;66:1076-81.

19. Morice MC, Serruys PW, Sousa JE, et al. and RAVEL Study Group. Randomized study with the sirolimus-coated Bx velocity balloon- expandable stent in the treatment of patients with de novo native coronary artery lesions A randomized comparison of a sirolimus- eluting stent with a standard stent for coronary revascularization. N Engl J Med 346(2002); 1773-80.

20. Grube E, Silber S, Hauptmann et al. TAXUS-I: six-and twelve-month results from a randomized, double-blind trial on a slow-release paclitaxel- eluting stent for de novo coronary lesions. Circulation 107(2003);38-42.

21. Park SJ, Shim WH, Ho DS, et al. A paclitaxel- eluting stent for the prevention of coronary restenosis. N Engl J Med 348(2003);1537-45.

22. Bonchek LI. More on hybrid revascularization. N Engl J Med 1997;337:861-62.

23. Katz MR, Praet FV, Canniere D, Murphy D, Siwek L, Seshadri-Kreaden U, et al. Integrated coronary revascularization: percutaneous coronary intervention plus robotic totally endoscopic coronary artery bypass. Circulation. 2006 Jul 4;114(1 Suppl):I473-6.

24. Kiaii B, McClure RS, Kostuk WJ, et al. 2005. Concurrent robotic hybrid revascularization using an enhanced operative suite. Chest 128: 4046-8.

25. Serruys P, Unger F, sousa J, et al. Comparison of coronary artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 344(2002);1117-24.

26. Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496-501.