Fedakar Ali, Taşar Mehmet, Rabus Murat Bülen, Alsalehi Saleh, Toker Mehmet Erdem, Balkanay Mehmet
Department of Cardiac Surgery, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
Heart Surg Forum. 2012 Feb;15(1):E51-5. doi: 10.1532/HSF98.20111116.
Hybrid coronary revascularization is an alternative for treatment for high-risk patients with coronary artery disease. We evaluated the efficacy of staged hybrid coronary revascularization for the treatment of unprotected left main coronary artery disease in high-risk patients.
Patients with left main or proximal left anterior descending coronary artery stenosis who are not good candidates for percutaneous coronary intervention and who had suitable lesions in the right coronary and circumflex arteries were considered for staged hybrid therapy if they had poor left ventricular functions (ejection fraction <0.40) and comorbid illnesses. From January 2008 through December 2010, 11 patients (8 men, 3 women; mean age: 66.1 ± 9.1 years) were treated with off-pump coronary artery bypass grafting combined with staged percutaneous coronary intervention. Nine patients had left main coronary artery stenosis together with circumflex or right coronary artery stenosis, and 2 patients had proximal left anterior descending artery stenosis and right coronary artery stenosis.
After off-pump coronary artery bypass grafting, procedure-related complications did not occur, and there was no in-hospital death. Coronary re-angiography after a median of 16 days revealed patent and functioning left internal mammarian artery grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty and occasional stenting (n = 14), a total of 14 lesions were treated successfully. Procedure related complications did not occur. All patients remained angina-free, and no stress electrocardiographic changes were recorded.
Our preliminary results indicate that a "staged hybrid" approach to the treatment of left main coronary artery disease in high-risk patients is safe and effective. Hybrid coronary revascularization enables complete revascularization and may be an alternative method of treating left main coronary artery disease in selected high-risk patients.
杂交冠状动脉血运重建术是治疗高危冠状动脉疾病患者的一种替代方法。我们评估了分期杂交冠状动脉血运重建术治疗高危患者无保护左主干冠状动脉疾病的疗效。
左主干或左前降支近端冠状动脉狭窄患者，若不适合经皮冠状动脉介入治疗，且右冠状动脉和回旋支有合适病变，同时左心室功能差（射血分数<0.40）且合并其他疾病，则考虑分期杂交治疗。从2008年1月至2010年12月，11例患者（8例男性，3例女性；平均年龄：66.1±9.1岁）接受了非体外循环冠状动脉旁路移植术联合分期经皮冠状动脉介入治疗。9例患者有左主干冠状动脉狭窄合并回旋支或右冠状动脉狭窄，2例患者有左前降支近端狭窄和右冠状动脉狭窄。
非体外循环冠状动脉旁路移植术后，未发生与手术相关的并发症，且无院内死亡。中位16天后的冠状动脉造影显示所有患者的左乳内动脉移植物通畅且功能良好。随后进行经皮冠状动脉腔内血管成形术并偶尔置入支架（n = 14），共成功治疗14处病变。未发生与手术相关的并发症。所有患者均无胸痛发作，且未记录到应激心电图改变。
我们的初步结果表明，对高危患者的左主干冠状动脉疾病采用“分期杂交”治疗方法是安全有效的。杂交冠状动脉血运重建术可实现完全血运重建，可能是治疗特定高危患者左主干冠状动脉疾病的一种替代方法。
