Possibility of the hybrid myocardial revascularization with full arterial bypass grafting of the left ventricle coronary arteries at multivascular affection
Objectives. To estimate immediate results of the proposed method of the hybrid myocardial revascularization (HMR) with full arterial bypass grafting of the left ventricle coronary arteries at the multivascular affection. Methods. 77 patients with the ischemic heart disease underwent the full minimally invasive coronary surgery (MICS) at multivascular affection from 2011 to 2012 in the cardiac surgery department of the Vitebsk Regional clinical hospital. The strategy of the MICS was focused on performing functionally adequate arterial revascularization of the left ventricle from the left-sided mini-thoracotomy as well as on avoidance the artificial blood circulation on the ascending aorta. In 7 (9,9%) cases hybrid approach with full arterial composite-sequential revascularization of the left ventricle was done as well as percutaneous transluminal coronary angioplasty of the right coronary artery (RCA) during the same hospitalization. Indications for the HMR were: inadequate visualization and positioning of the branches of the RCA with high risk of the cardiopulmonary bypass; high probability of the competitive blood flow in the RCA-system after revascularization from the left internal mammary artery. Mean age was 59,4 years, all patients were male. 3 (42,9%) patients had hemodynamically significant affection of the left coronary artery trunk. Results. There were no lethal outcomes in the studied group as well as emergency conversions to the cardiopulmonary bypass and sternotomy. Intraoperative inotropic support was not used, 3 (42,9%) patients underwent vasopressor therapy. Immediate results of the HMR showed a low rate of the perioperative complications and are associated with short period of ICU – stay and reduced hospital length of stay. Conclusions. Hybrid approach with full arterial revascularization of the left ventricle is feasible in patients with multivascular coronary artery affection. The proposed method broadens indications to hybrid myocardial revascularization. Its application is supposed to reduce the number of complications, to improve long-term results, to cut down cost of treatment. Further investigations are necessary to confirm these assumptions.