Cisowski Marek, Morawski Wlodzimierz, Drzewiecki Janusz, Kruczak Wojciech, Toczek Krzysztof, Bis Jaroslaw, Bochenek Andrzej
First Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
Eur J Cardiothorac Surg. 2002 Aug;22(2):261-5. doi: 10.1016/s1010-7940(02)00262-2.
Minimally invasive direct coronary artery bypass (MIDCAB) through the anterolateral minithoracotomy has become a promising therapeutic option in patients with lesion in left anterior descending artery (LAD), especially in multimorbid, elderly and reoperated patients with type C or B lesions. To expand the benefits of MIDCAB concept to patients with multivessel disease, a hybrid myocardial revascularization procedure (HMR) combining surgery of the LAD with interventional procedures for additional coronary lesions has recently been introduced.
Between January 1999 and September 2001, 50 patients (37 male, 13 female, mean age 54.8+/-20.1 years) underwent an HMR procedure. MIDCAB with endoscopic left internal thoracic artery (LITA) harvesting, followed by percutaneous coronary intervention (PCI) for additional coronary lesions and percutaneous transluminal coronary angioplasty (PTCA), was performed in 11 patients (22%) and stenting in 39 patients (78%). Angiographic assessment of graft patency was performed in all patients during the PCI procedure. The clinical follow-up period was 3-32 months.
There were no early and late deaths. Baseline Canadian Cardiology Society (CCS) class was 2.8+/-0.7 versus 1.1+/-0.9 (P<0.001) 30 days after HMR procedure. There were no major acute in-hospital cardiac events. Angiographic studies showed patent LIMA-LAD graft in 50 patients (100%). We showed good quality of anastomosis in 49 patients (98%). There was a moderate graft stenosis in one patient (2%). At long term follow-up, the rate of major cardiac events was 12%. Five patients (10%) developed restenosis after PCI, and one patient (2%) developed significant stenosis in site of LITA-LAD anastomosis; redo PCI was performed successfully.
The hybrid procedure is a safe and effective method for complete revascularization in selected patients with double-vessel coronary artery disease (patients with type B or C lesions in the proximal LAD). This method allows performance of complete revascularization with minimization of surgical trauma. So far, long-term results of HMR are limited by the results of PCI.
经前外侧小切口的微创直接冠状动脉旁路移植术（MIDCAB）已成为左前降支（LAD）病变患者，尤其是患有多种疾病、老年以及再次手术的C型或B型病变患者一种有前景的治疗选择。为了将MIDCAB理念的益处扩展至多支血管病变患者，最近引入了一种将LAD手术与针对其他冠状动脉病变的介入手术相结合的杂交心肌血运重建术（HMR）。
1999年1月至2001年9月期间，50例患者（37例男性，13例女性，平均年龄54.8±20.1岁）接受了HMR手术。11例患者（22%）接受了采用内镜下获取左乳内动脉（LITA）的MIDCAB，随后对其他冠状动脉病变进行经皮冠状动脉介入治疗（PCI）及经皮腔内冠状动脉成形术（PTCA），39例患者（78%）接受了支架置入术。在PCI过程中对所有患者进行了移植血管通畅性的血管造影评估。临床随访期为3至32个月。
无早期和晚期死亡病例。HMR术后30天，基线加拿大心血管学会（CCS）分级为2.8±0.7，而术后为1.1±0.9（P<0.001）。无重大急性院内心脏事件。血管造影研究显示50例患者（100%）的左内乳动脉-左前降支移植血管通畅。49例患者（98%）显示吻合质量良好。1例患者（2%）存在移植血管中度狭窄。长期随访时，重大心脏事件发生率为12%。5例患者（10%）PCI术后发生再狭窄，1例患者（2%）LITA-左前降支吻合部位出现明显狭窄；成功进行了再次PCI。
杂交手术是一种安全有效的方法，可用于对选定的双支血管冠状动脉疾病患者（近端LAD的B型或C型病变患者）进行完全血运重建。该方法能够在手术创伤最小化的情况下实现完全血运重建。到目前为止，HMR的长期结果受PCI结果的限制。
