|
Replies:
3
-
Pages:
1
-
Last Post:
Nov 4, 2009 4:17 PM
by: Kevin Richardson
|
Threads:
[
Previous
|
Next
]
|
|
Posts:
49
Registered:
9/23/08
|
|
|
|
Hybrid Revascularization
Posted:
Aug 29, 2004 4:16 PM
|
|
[nobr]Editor Mercedes Dullum has introduced this topic for evaluation and discussion with an Editorial, and additional commentaries by four physicians -- a cardiologist, and anesthesiologist, and two cardiac surgeons. This is a lively subject, and will likely become an important direction for cardiac surgeons in the future. Read the contributions at http://www.ctsnet.org/doc/9460, and then share your thoughts in this discussion thread.
Tom Ferguson [/nobr]
|
|
Posts:
2
Registered:
9/23/08
|
|
|
|
Posted:
Nov 3, 2004 12:03 PM
in response to: Thomas Ferguson
|
|
I would ask Dr. Dullum and colleagues to consider the following potential other type of hybrid revascularization- what I have titled "Hybrid surgical revascularization". In our daily practice we are facing with growing challenges to perform complete revascularization in the setting of vessels that have been rendered nearly technically unbypassable due to multiple previous intervention (stents, etc.). I think we can all agree that this problem now occurs daily in our surgical patients. Assuming we have grafted the LAD with a LIMA- should we then risk attempting to bypass remaining diseased distal vessels of 0.8 -1.0 mm in order to perform the recommended "complete re-vascularization? ? What is the risk of early graft closure in this setting? - and the risk of the resultant peri-operative MI- with it's associated morbidity and mortality? Even if early patency is achieved, what chance does this graft (be it arterial or venous) have to be patent at one, five or ten years with such low runoff ? As Dr. Dullum suggests LIMA-LAD plus PTCA intervention- "hybrid revascularization" is one reasonable approach to this problem. Consider another- "hybrid surgical revascularization or so-called hybrid CABG" with LIMA-LAD (preferably off-pump) combined with TMR to those areas of the heart ischemic but supplied by vessels as described above. In fact we have previously published excellent results with just such an approach (Vidal J, Cuenta J, Grosso MA: OPCAB with Holmiuim:YAG TMR offers complete revascularization with excellent operative results and sustained angina relief. Heart Surgery Forum, 5 (Suppl. 2), 192, 2002 and Grosso MA: Hybrid Surgical Revascularization: CABG of the Future. Heart SurgeryForum 6 (5), 4472, 2003. TMR may not the ultimate answer for complete coronary revascularization- but it is a viable approach, and importantly one that remains the province of the surgeon!
|
|
Posts:
8
Registered:
9/23/08
|
|
|
|
Re: Hybrid Revascularization
Posted:
Sep 24, 2008 8:13 AM
in response to: Thomas Ferguson
|
|
In my coronary surgery practice of 100% all comers OPCAB, there are two main indications for Hybrid operation. 1 : If the coronaries can not be found and the patient is symptomatic post op. 2: If there is no grafts other done Lima.
You know " It is one thing to be in a hijacked plain and see that all of the passengers are developing sympathy for the hijackers, and it is a whole different thing to know that the high jackers have a wooden toy gun."
|
|
Posts:
6
Registered:
9/23/08
|
|
|
|
Re: Hybrid Revascularization
Posted:
Nov 4, 2009 4:17 PM
in response to: Thomas Ferguson
|
|
What exactly is Hybrid revascularization? LIMA-LAD OPCAB, followed by PTI to another vessel? Hasn't this been occuring already? I guess the only difference is that it is done in the same setting. Is this good for the patient? For years, the standard practice for elective CABG was to wait a least 24 hours after cath, to decrease risk of acute renal insufficiency assoc with CABG. Now were are doing surgery and caths on the same day electively? What good can come from stenting vessels illsuited for stenting? Stenting a 0.8mm vessel will not help the patient, as the stent will close. The criteria for stenting dictates a "suitable" target, i.e., greater than 2mm. The viabilty of the stent can not be assured in a vessel less than 2. It says so on the package insert. Simply do the LIMA-LAD, and TMR, and leave the cardiologist out of it. Secondly, how can hospitals be going for this? They will lose countless money by allowing 2 procedures to be done at the same time. There is no data supporting its use, therefore reimbursements will reflect a lesser DRG= less money. The only hybrid OR should be an endovascular suite.
|
|
|
|
