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Not Missing A Beat

Seated at a monitor displaying endoscopic images of the surgical field, Dr. Lucian Lozonschi performs robotic CABG
Seated at a monitor displaying endoscopic images of the surgical field, Dr. Lucian Lozonschi performs robotic CABG.

A hybrid approach to coronary revascularization

The most feared myocardial infarction, known colloquially as the “widow maker,” occurs when the left anterior descending artery (LAD), which runs down the front of the heart and supplies the front and main wall, is critically blocked by plaque buildup. Coronary artery bypass grafting (CABG) has long been the gold standard for treating blockage of the LAD due to coronary artery disease (CAD), especially in patients with multivessel disease1 or diabetes.2

However, traditional CABG requires that the chest be fully open to reach the heart, and then that the heart be stopped during the operation, necessitating use of cardiopulmonary bypass. When percutaneous coronary intervention (PCI) with drug-eluting stents began to show similar short-term outcomes as open CABG but with shorter recovery times, many patients opted for the less invasive approach because it could be performed without cardiopulmonary bypass and without opening the chest. This approach can also be used in patients who are not good candidates for open CABG. Results are not as durable as with LIMA to LAD CABG, however, and repeated revascularization is often necessary.2 In contrast, PCI has achieved better long-term results than CABG for non-LAD blockages.3

Hybrid coronary revascularization (HCR) maximizes the strengths of both approaches while minimizing their drawbacks. The LIMA to LAD bypass is performed with the help of a surgical robotic system, and then PCI is used to open up any non-LAD blockages. The patient benefits from the durability of the CABG procedure and the superior outcomes of PCI for non-LAD blockages without having to experience the prolonged recovery and surgical morbidity associated with traditional open CABG. A follow-up study of the POLMIDES (NCT01035567) trial, which compared HCR to traditional CABG in 200 patients, found similar rates of survival at five years for the two approaches.3

“Hybrid coronary revascularization is using the best of both worlds to treat coronary artery disease,” says Lucian Lozonschi, M.D., director of surgical heart failure and cardiac transplantation at the MUSC Health Heart and Vascular Center.

References

1. Hillis LD, et al. J Thorac Cardiovasc Surg. 2012;143:4-34.

2. Investigators B. J Am Coll Cardiol. 2007;49(15):1600-1606.

3. Tajstra et al. JACC: Cardiovasc Interven. May 14, 2018;11(9):847-852.