Abstract 3051: A Novel Approach to Hybrid Coronary Artery Revascularization Using Bivalirudin
OBJECTIVE: Traditionally, hybrid coronary artery revascularization, a combination of minimally invasive coronary artery bypass grafting and percutaneous coronary intervention (PCI), has been described as a two-stage procedure. We report our experience with one-stage hybrid robotic-assisted coronary artery bypass grafting and PCI .
Methods: 35 patients underwent concurrent hybrid coronary artery revascularization at our institution. 31 were males; mean age was 59 years (41– 82 years). All internal thoracic arteries were harvested with robotic-assistance, and all anastomoses were manually constructed through a mini-thoracotomy without cardiopulmonary bypass. Subsequently, at the same time in the same operating room, graft patency was confirmed and PCI (13 right, 9 Diagonal, and 13 circumflex coronary arteries) was carried out using drug-eluting stents. In 28 patients bivalirudin was utilized during the entire procedure.
Results: There were no mortalities, no wound infections, and one peri-operative myocardial infarction. Length of stay in the intensive care unit averaged 1 day and median length of hospital stay was 4 days. Three patients required post-operative exploration for bleeding. One patient had a stroke. All patients were free of symptoms at 20 months follow-up. Nineteen patients have had 6 months angiographic follow-up, with all bypass grafts being patent and one stent occluded.
Conclusions: Concurrent robotic-assisted hybrid coronary artery revascularization using bivalirudin is safe and feasible. This approach allows complete multivessel revascularization with decreased surgical trauma and postoperative morbidity. Further results are necessary to determine patient selection and long term benefits.