Giambruno Vincenzo, Hafiz Ahmad, Fox Stephanie A, Jeanmart Hugues, Cook Richard C, Khaliel Feras H, Teefy Patrick, Sridhar Kumar, Lavi Shahar, Bagur Rodrigo, Randhawa Varinder K, Iglesias Ivan, Jones Philip M, Harle Christopher C, Bainbridge Daniel, Chu Michael W A, Kiaii Bob B
From the *Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada; †Division of Cardiac Surgery, University of Montreal, Montreal Heart Institute, Montreal, Quebec, Canada; ‡Division of Cardiac Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada; and §Division of Cardiology, Department of Medicine, ∥Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada.
Innovations (Phila). 2017 Mar/Apr;12(2):82-86. doi: 10.1097/IMI.0000000000000355.
Hybrid coronary revascularization offers and combines the advantages of both surgical and percutaneous revascularization and eliminates at the same time the disadvantages of both procedures. The objective of this study was to assess graft and stent patency at 6 months, rate of bleeding, intensive care unit and hospital stay, rate of reintervention, and long-term clinical follow-up.
From March 2004 to November 2015, a total of 203 patients underwent robotic-assisted minimally invasive direct coronary artery bypass graft of the left internal thoracic artery to the left anterior descending artery and PCI of a non-left anterior descending vessel in a single or two stage, at three different centers. Patients underwent 6-month angiographic follow-up. The mean ± SD clinical follow-up was 77.82 ± 41.4 months.
Successful hybrid coronary revascularization occurred in 196 of the 203 patients. One hundred forty-six patients underwent simultaneous surgical and percutaneous intervention. Nineteen patients underwent PCI before surgery, and 38 patient underwent PCI after surgery. No in-hospital mortality occurred. The mean ± SD ICU stay was 1 ± 1 days and the mean ± SD hospital stay was 5 ± 2 days. Only 13.3% of the patients required a blood transfusion. Six-month angiographic follow-up has been performed in the 95 patients, and it demonstrated a left internal thoracic artery anastomotic patency of 97.9% and stent patency of 92.6%. A total of 77.8 ± 41.4-month clinical follow-up demonstrated 95.1% survival, 92.6% freedom from angina, and 90.7% freedom from any form of coronary revascularization.
Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes.
杂交冠状动脉血运重建兼具外科和经皮血运重建的优势，同时消除了两种手术方式的劣势。本研究的目的是评估6个月时移植血管和支架的通畅情况、出血率、重症监护病房（ICU）停留时间和住院时间、再次干预率以及长期临床随访情况。
2004年3月至2015年11月，共有203例患者在三个不同中心分一或两期接受了机器人辅助的微创左胸廓内动脉至左前降支冠状动脉搭桥术以及非左前降支血管的经皮冠状动脉介入治疗（PCI）。患者接受了6个月的血管造影随访。平均±标准差的临床随访时间为77.82±41.4个月。
203例患者中有196例成功进行了杂交冠状动脉血运重建。146例患者接受了同期外科和经皮介入治疗。19例患者在手术前接受了PCI，38例患者在手术后接受了PCI。无院内死亡发生。平均±标准差的ICU停留时间为1±1天，平均±标准差的住院时间为5±2天。仅13.3%的患者需要输血。95例患者进行了6个月的血管造影随访，结果显示左胸廓内动脉吻合口通畅率为97.9%，支架通畅率为92.6%。平均77.8±41.4个月的临床随访显示生存率为95.1%，无心绞痛发生率为92.6%，无任何形式冠状动脉血运重建的发生率为90.7%。
杂交冠状动脉血运重建似乎是一种有前景且安全的血运重建策略。它为特定患者提供了一种功能上完全的血运重建替代方案，手术创伤极小，长期临床效果良好。
