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HYBRID CORONARY INTERVENTION by Johannes Bonatti, MD FETCS Chief of Cardiothoracic Surgery


Combines minimally invasive CABG and PCI Brings “The Best of Two Worlds” together” Represents an alternative to CABG through sternotomy and multivessel PCI

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LIMA to LAD - best choice for the anterior wall Stents to non-LAD targets equal or better than vein grafts or even arterial grafts (RA) Two IMA grafts to the left ventricle are a proven success-factor for survival

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“LIMA TO LAD FOR SURVIVAL – STENTS FOR SYMPTOMS”

D. Zimrin 2010

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INDICATIONS

Complex LAD lesion + Lesions on non-LAD targets amenable to PCI LM-lesions +/- stentable RCA or Cx system

Complex PCI bifurcation targets

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Beating heart TECAB LIMA-LAD Graft angiography and LM-PCI POD #3


CONVERSION OF COMPLEX PCI LESIONS INTO RELATIVELY SIMPLE ONES

Trans Endoscopic Coronary Artery

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59 y.o. male, angina, HTN, Chol, DM.

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IDEAL TIMEPOINT FOR PCI AFTER LESS INVASIVE SURGERY ??

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CONSIDER Is bleeding well under control? Can the patient lie flat on the angio-table? Is there confusion or agitation? May a perioperative other intervention be necessary (e.g. pleurocentesis)

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The surgical result needs to be perfect before you proceed to PCI Perioperative angios are sometimes difficult to interpret (Learning curve)

Trans Endoscopic Coronary Artery

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WHEN TO DO PCI FIRST?

Acute PCI Nasty lesions/high risk lesions

Trans Endoscopic Coronary Artery

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FUTURE? HERE TO STAY INTEREST BY INTERVENTIONAL CARDIOLOGISTS RESULTS OF OBSERVATIONAL NIH STUDY T PROSPECTIVE RANDOMIZED TRIALS MORE ADVANCED HYBRID INTERVENTIONS

Trans Endoscopic Coronary Artery

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SHA24/068005  

Presentation

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