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Hybrid coronary revascularization in the era of drug-eluting stents.
- Source :
-
The Annals of thoracic surgery [Ann Thorac Surg] 2004 Nov; Vol. 78 (5), pp. 1861-7. - Publication Year :
- 2004
-
Abstract
- Left internal mammary artery to left anterior descending coronary artery bypass grafting integrated with percutaneous coronary angioplasty (hybrid procedure) offers multivessel revascularization with minimal morbidity in high-risk patients. This is caused in part by the avoidance of cardiopulmonary bypass-related morbidity and manipulation of the aorta coupled with minimally invasive techniques. Hybrid revascularization is currently reserved for particularly high-risk patients or those with favorable anatomic variants however, largely because of the emergence of off-pump coronary artery bypass grafting, which permits more complete multivessel revascularization, with low morbidity in high-risk groups. The wider introduction of hybrid revascularization is limited chiefly by the high number of repeat interventions compared with off-pump coronary artery bypass grafting, which occurs because of the target vessel failure rate of percutaneous coronary intervention. Other demerits are the costs and logistic problems associated with performing two procedures with differing periprocedural management protocols. Recently, drug-eluting stents have reduced the need for repeat intervention after percutaneous coronary intervention, and this has raised the possibility that the results of hybrid revascularization may now equal or even better those of off-pump coronary artery bypass grafting. Although undoubtedly effective at reducing in-stent restenosis, drug-eluting stents will not address the issues of incomplete revascularization or the logistic problems associated with hybrid. Uncertainty regarding the long-term effectiveness of drug-eluting stents in many patients, as well as their high cost when compared with those of off-pump coronary artery bypass grafting surgery, also militates against the wider introduction of hybrid revascularization.
- Subjects :
- Adult
Aged
Aged, 80 and over
Cohort Studies
Combined Modality Therapy
Coronary Artery Bypass, Off-Pump
Coronary Restenosis prevention & control
Coronary Restenosis surgery
Disease-Free Survival
Evaluation Studies as Topic
Female
Hospital Mortality
Humans
Internal Mammary-Coronary Artery Anastomosis instrumentation
Length of Stay statistics & numerical data
Male
Middle Aged
Minimally Invasive Surgical Procedures
Multicenter Studies as Topic
Myocardial Ischemia drug therapy
Myocardial Ischemia surgery
Paclitaxel administration & dosage
Paclitaxel therapeutic use
Prospective Studies
Randomized Controlled Trials as Topic
Reoperation
Retrospective Studies
Sirolimus administration & dosage
Sirolimus therapeutic use
Treatment Outcome
Angioplasty, Balloon, Coronary
Drug Implants
Internal Mammary-Coronary Artery Anastomosis methods
Myocardial Ischemia therapy
Stents
Subjects
Details
- Language :
- English
- ISSN :
- 1552-6259
- Volume :
- 78
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The Annals of thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 15511503
- Full Text :
- https://doi.org/10.1016/j.athoracsur.2004.07.024