Friday, September 26, 2014

Hybrid Coronary Revascularisation

This is a dynamic piece and will change as I learn more about this procedure.

The latest project I am working on is about hybrid coronary revascularization, a procedure I learnt about thanks to my work with KP.

It is a novel concept that I am very interested in and combines the skills of both the interventionalist and the cardiothoracic surgeon.

Off-pump CABG (LIMA to LAD) is performed via a mini-sternotomy (small anterior thoracotomy incisions) rather than the standard thoracotomy that would be used in a traditional CABG. The procedure is performed with the help of a robot, similar to laparoscopic surgery in other fields. However, the lack of a large incision makes it difficult to access the posterior and lateral aspects of the heart and as such, complete revascularisation will not be possible using this minimally invasive procedure, particularly with the RCA and LCx. As such, non-LAD stenoses are revascularised using PCI and drug eluting stents. This has the added benefit of a extended patency (of stents) rather than the saphenous vein graft which is prone to revascularization.

It is thought that PCIs last longer than saphenous vein grafts but traditionally the later has been used - presumably because if you are going to go through an invasive procedure like the traditional CABG you might as well sort out all the blockages?

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