Simultaneous hybrid revascularization by peripheral artery stenting and off-pump coronary artery bypass: the early results

Abstract

Background: In order to minimize the adverse events in patients with elevated cardiovascular surgical risk, we investigated a new therapeutic strategy consisting of simultaneous hybrid revascularization by peripheral artery stenting, immediately followed with off-pump coronary artery bypass in a special hybrid operating room.

Methods: From January 2008 to November 2009, 18 consecutive patients received the hybrid revascularization under general anesthesia. We first implanted stents in the carotid, renal, and subclavian arteries which had stenosis greater than 70%; the patients then received off-pump coronary artery bypass. The primary endpoint was the incidence of stroke, myocardial infarction, renal failure, and death. Secondary endpoints were a combination of transient ischemic attack, major local complications, bleeding, and systemic complications.

Results: The hybrid revascularization was successful in 18 patients (100%). There were no procedure-related complications and no in-hospital death. The postoperative courses were uneventful with the exception of 2 patients who suffered from stroke, and no vital organ dysfunction occurred. The mean number of implanted stents and coronary grafts were 1.6 ± 0.6 and 3.1 ± 0.7, respectively. The ventilation time ranged from 10 to 93 hours (mean, 29.2 ± 26.0 hours). The intensive care unit stay was 74.2 ± 45.7 hours and the mean postoperative hospital stay was 9.3 ± 3.0 days.

Conclusions: Our findings indicate that in high-risk surgical patients with peripheral artery stenosis and coronary artery disease, hybrid revascularization by peripheral artery stenting, immediately followed with off-pump coronary artery bypass, is a feasible, less invasive therapeutic strategy.