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Hybrid-Revaskularisation bei koronarer Mehrgefäßerkrankung

Hybride revascularization in multiple coronary vessel disease

  • Themenschwerpunkt: Minimal Invasive Herzchirurgie
  • Published:
Acta chirurgica Austriaca Aims and scope Submit manuscript

Zusammenfassung

Grundlagen: Dem Patienten mit koronarer Mehrgefäßerkrankung können bezüglich Revaskularisation mehrere Verfahren angeboten werden. Neben der konventionellen Bypass-Operation oder der Mehrgefäßangioplastie ergibt sich, nach der Einführung der minimal invasiven Bypasschirurgie am schlagenden Herzen (MIDCAB = minimally invasive direct coronary artery bypass), die Möglichkeit der koronaren „Hybrid-Revaskularisation“.

Methodik: Im Zeitraum von Juli bis Dezember 1996 haben wir die Hybrid-Revaskularisation bei 2 ausgewählten Patienten angewandt. Bei diesem Verfahren werden dem Patienten mit koronarer 2-Gefäßerkrankung sequentiell mittels MIDCAB und Ballonangioplastie beide Gefäße minimal invasiv revaskularisiert.

Ergebnisse: Beide Fälle ergaben gute klinische Primärergebnisse mit angiographisch aufgezeigten offenen LIMA-(Left internal mammary artery = A. mammaria interna) Grafts zur LAD (Left anterior descending artery = R. interventricularis anterior) sowie guten interventionellen Ergebnissen an der RCA (Right coronary artery = A. coronaria dextra).

Schlußfolgerungen: Wir konnten die problemlose technische Durchführbarkeit des Verfahrens zeigen, Langzeitbeobachtungsstudien sowie prospektive randomisierte Vergleichsstudien mit Mehrgefäß-PTCA und konventioneller Bypass-Operation sind aber nötig, um den Stellenwert der Hybridrevaskularisation im kardiologisch/kardiochirurgischen Therapierepertoire definieren zu können.

Summary

Background: In patients with multiple coronary vessel disease several revascularization procedures may be applied. Besides conventional coronary artery bypass surgery and multiple coronary artery angioplasty, a new coronary “hybrid revascularization” procedure may be performed.

Methods: Between July and December 1996 this minimally invasive strategy allowing complete coronary revascularization was performed in 2 selected cases at our institution. In this revascularization concept the patient is first undergoing minimally invasive direct coronary bypass (MIDCAB) surgery on the beating heart to one diseased coronary vessel. In a second step a balloon angioplasty of the second coronary lesion is performed.

Results: In both patients excellent clinical and angiographic short term results could be achieved showing patent LIMA (left internal mammary artery) to LAD (left anterior descending artery) grafts and satisfactory results after catheter based intervention at the RCA (right coronary artery).

Conclusions: We were able to show the technical feasibility of the new technique. Nevertheless longterm observational studies and prospective randomized trials comparing hybrid coronary revascularization with multivessel interventional procedures and conventional coronary artery bypass grafting are necessary to define its role in the interventional and cardiosurgical treatment of coronary artery disease.

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Authors and Affiliations

  1. Klinische Abteilung für Kardiologie, Universitätsklinik für Innere Medizin, Anichstraße 35, A-6020, Innsbruck, Austria

    G. J. Friedrich, N. Moes, V. Mühlberger & O. Pachinger

  2. Klinischen Abteilung für Allgemeinchirurgie I, Herzchirurgie der Universit;atsklinik für Chirurgie, Innsbruck, Austria

    O. Dapunt, J. Bonatti & L. Ch. Müller

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  1. G. J. Friedrich
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  2. N. Moes
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  3. V. Mühlberger
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  4. O. Dapunt
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  5. J. Bonatti
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  6. L. Ch. Müller
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  7. O. Pachinger
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Friedrich, G.J., Moes, N., Mühlberger, V. et al. Hybrid-Revaskularisation bei koronarer Mehrgefäßerkrankung. Acta Chir Austriaca 30, 20–21 (1998). https://doi.org/10.1007/BF02619844

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  • DOI: https://doi.org/10.1007/BF02619844

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