Document Detail


Hybrid coronary revascularization in the era of drug-eluting stents.
MedLine Citation:
PMID:  15511503     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Gavin J Murphy; Alan J Bryan; Gianni D Angelini
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  78     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Nov 
Date Detail:
Created Date:  2004-10-29     Completed Date:  2005-02-04     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1861-7     Citation Subset:  AIM; IM    
Affiliation:
Bristol Heart Institute, University of Bristol, Bristol, United Kingdom.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary*
Cohort Studies
Combined Modality Therapy
Coronary Artery Bypass, Off-Pump
Coronary Restenosis / prevention & control,  surgery
Disease-Free Survival
Drug Implants*
Evaluation Studies as Topic
Female
Hospital Mortality
Humans
Internal Mammary-Coronary Artery Anastomosis / instrumentation,  methods*
Length of Stay / statistics & numerical data
Male
Middle Aged
Multicenter Studies as Topic
Myocardial Ischemia / drug therapy,  surgery,  therapy*
Paclitaxel / administration & dosage,  therapeutic use
Prospective Studies
Randomized Controlled Trials as Topic
Reoperation
Retrospective Studies
Sirolimus / administration & dosage,  therapeutic use
Stents*
Surgical Procedures, Minimally Invasive
Treatment Outcome
Chemical
Reg. No./Substance:
0/Drug Implants; 33069-62-4/Paclitaxel; 53123-88-9/Sirolimus

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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