Prospective randomized studies have clarified the surgical and medical indications in the
care of coronary arterial disease. However, the best therapy remains a matter of debate in
numerous borderline instances, namely because surgery has not proven clear cut superiority
to PTCA in the treatment of multiple vessel disease. In addition, cost containment has
become an important factor in decision making, appealing for the development of
alternative strategies.
We report the feasibility, complications, costs and the recurrence of coronary events of a
hybrid approach combining PTCA and off-pump direct coronary artery bypass through
minithoracotomy (MIDCABG) in the treatment of multitroncular disease. Ten patients were
selected with non-dilatable tight left anterior descending lesions, having secondary lesions
on the other vessels suitable for PTCA and suffering from functional ischemia in the LAD
territory. They all underwent PTCA on day 0; MIDCABG on day 1; angiogram on day 4; and
MiBi stress test on day 180. No patient scheduled for the study was dismissed or converted.
No operative and postoperative complications, including atrial fibrillation, occurred (in
particular no enzyme elevation). Graft patency rate was 100 %, and no remainder lesions
superior to 20 % was noted in target vessels. After a mean follow up of 6 months no
patient exhibited angina recurrence, myocardial infarction or death. Average cost was
10,000 US $ in the hybrid group compared to 12,000 US $ for a double CABG in our
institution.
In conclusion, a hybrid approach combining PTCA and surgery enlarges the potential
indications of minimally invasive revascularization with a very low rate of complications and
short term recurrence of coronary events. It offers an alternative treatment for complete
revascularization in selected patients.