Electrocoagulation-free Strategy in Minimally Invasive Direct Coronary Artery Bypass with Hybrid Revascularisation - a Case Report

Overview

Journal J Cardiothorac Surg

Publisher Biomed Central

Date 2025 Jan 20

PMID 39833866

Authors

Carla L Schuering

Leonhard Wert

Johanna K R von Mackensen

Vanessa I T Zwaans

Julius Kaemmel

Roland Heck

Christoph T Starck

Jorg Kempfert

Stephan Jacobs

Volkmar Falk

Alaa Abd El Al

Affiliations

Soon will be listed here.

Abstract

Background: Hybrid coronary revascularisation benefits patients with multivessel disease, as it amalgamates the minimally invasive direct coronary artery bypass (MIDCAB) procedure and percutaneous coronary intervention (PCI). We present a 63-year-old female with triple-vessel coronary artery disease including marked ostial stenosis of the left main coronary artery, as well as moderate stenosis of the right coronary artery. The risk of death following heart surgery (EuroSCORE II) is 4.27%. The patient exhibited multiple morbidities including chronic obstructive pulmonary disease, renal impairment, extracardiac arteriopathy, and multiple prior gastrointestinal surgeries, as well as a recent episode of paroxysmal atrial fibrillation. A MIDCAB procedure without electrocoagulation was stipulated by the ENT specialist due to the patient's cochlear implant.

Conclusion: A successful MIDCAB procedure omitting electrocoagulation was performed for the first time for multivessel coronary disease in a multimorbid patient as part of a hybrid approach.

References

Tognola G, Parazzini M, Sibella F, Paglialonga A, Ravazzani P . Electromagnetic interference and cochlear implants. Ann Ist Super Sanita. 2007; 43(3):241-7. View

Calafiore A, Giammarco G, Teodori G, Bosco G, DAnnunzio E, Barsotti A . Left anterior descending coronary artery grafting via left anterior small thoracotomy without cardiopulmonary bypass. Ann Thorac Surg. 1996; 61(6):1658-63; discussion 1664-5. DOI: 10.1016/0003-4975(96)00187-7. View

Van Praet K, Kofler M, Shafti T, Al A, van Kampen A, Amabile A . Minimally Invasive Coronary Revascularisation Surgery: A Focused Review of the Available Literature. Interv Cardiol. 2021; 16:e08. PMC: 8287382. DOI: 10.15420/icr.2021.05. View

Toeg H, Al-Atassi T, Labinaz M, Le May M, Ruel M . Hybrid approach for coronary artery revascularization: where do we stand?. Curr Opin Cardiol. 2014; 29(6):534-41. DOI: 10.1097/HCO.0000000000000112. View

Ruel M, Une D, Bonatti J, McGinn J . Minimally invasive coronary artery bypass grafting: is it time for the robot?. Curr Opin Cardiol. 2013; 28(6):639-45. DOI: 10.1097/HCO.0b013e3283653fd1. View

Behan J, Higgins S, Wysong A . Safety of Cochlear Implants in Electrosurgery: A Systematic Review of the Literature. Dermatol Surg. 2017; 43(6):775-783. DOI: 10.1097/DSS.0000000000001095. View

Vassiliades Jr T, Douglas J, Morris D, Block P, Ghazzal Z, Rab S . Integrated coronary revascularization with drug-eluting stents: immediate and seven-month outcome. J Thorac Cardiovasc Surg. 2006; 131(5):956-62. DOI: 10.1016/j.jtcvs.2005.10.058. View

Repossini A, Tespili M, Saino A, Kotelnikov I, Moggi A, Di Bacco L . Hybrid revascularization in multivessel coronary artery disease. Eur J Cardiothorac Surg. 2013; 44(2):288-93. DOI: 10.1093/ejcts/ezt016. View

Serruys P, Morice M, Kappetein A, Colombo A, Holmes D, Mack M . Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med. 2009; 360(10):961-72. DOI: 10.1056/NEJMoa0804626. View

10.

Murphy G, Bryan A, Angelini G . Hybrid coronary revascularization in the era of drug-eluting stents. Ann Thorac Surg. 2004; 78(5):1861-7. DOI: 10.1016/j.athoracsur.2004.07.024. View

11.

Messerli A, Misumida N . Hybrid Coronary Revascularization 5 Years On: Is Clinical Equipoise Good Enough?. JACC Cardiovasc Interv. 2018; 11(9):853-855. DOI: 10.1016/j.jcin.2018.02.009. View

12.

Repossini A, Moriggia S, Cianci V, Parodi O, Sganzerla P, BALDRIGHI G . The LAST operation is safe and effective: MIDCABG clinical and angiographic evaluation. Ann Thorac Surg. 2000; 70(1):74-8. DOI: 10.1016/s0003-4975(00)01413-2. View

13.

Gaudino M, Benedetto U, Fremes S, Biondi-Zoccai G, Sedrakyan A, Puskas J . Radial-Artery or Saphenous-Vein Grafts in Coronary-Artery Bypass Surgery. N Engl J Med. 2018; 378(22):2069-2077. DOI: 10.1056/NEJMoa1716026. View

14.

Nagraj S, Tzoumas A, Kakargias F, Giannopoulos S, Ntoumaziou A, Kokkinidis D . Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta-analysis of 14 studies comprising 4226 patients. Catheter Cardiovasc Interv. 2022; 100(7):1182-1194. DOI: 10.1002/ccd.30446. View

15.

Tonino P, De Bruyne B, Pijls N, Siebert U, Ikeno F, van t Veer M . Fractional flow reserve versus angiography for guiding percutaneous coronary intervention. N Engl J Med. 2009; 360(3):213-24. DOI: 10.1056/NEJMoa0807611. View

16.

Angelini G, Wilde P, Salerno T, Bosco G, Calafiore A . Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet. 1996; 347(9003):757-8. DOI: 10.1016/s0140-6736(96)90107-5. View

17.

Yu L, Zhu K, Du N, Si Y, Liang J, Shen R . Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients with multivessel coronary artery disease: a meta-analysis. J Cardiothorac Surg. 2022; 17(1):147. PMC: 9175312. DOI: 10.1186/s13019-022-01903-w. View

18.

Halkos M, Vassiliades T, Myung R, Kilgo P, Thourani V, Cooper W . Sternotomy versus nonsternotomy LIMA-LAD grafting for single-vessel disease. Ann Thorac Surg. 2012; 94(5):1469-77. DOI: 10.1016/j.athoracsur.2012.05.049. View

19.

Byrne J, Leacche M, Vaughan D, Zhao D . Hybrid cardiovascular procedures. JACC Cardiovasc Interv. 2009; 1(5):459-68. DOI: 10.1016/j.jcin.2008.07.002. View