Angioplasty/stenting, keyhole bypass are combined in a 'first'.

AHA 2004

Angioplasty/stenting, keyhole bypass are combined in a first

By DON LONG

CDU Managing Editor

NEW ORLEANS Cream and sugar, Martin and Lewis, coughs and colds are well-known pairings. An innovative combination coronary stenting teamed with additional partners was reported on in a poster session during Novembers annual scientific sessions of the American Heart Association (Dallas) at the Ernest N. Morial Convention Center alongside the Mississippi River downtown.

Belgian researchers said that stented angioplasty combined with robotically assisted keyhole bypass surgery to treat different parts of the coronary vasculature is safe and may benefit patients with cardiovascular disease who also have difficult-to-treat vascular conditions or related co-morbidities.

Bernard De Bruyne, MD, PhD, study co-author and head of the catheterization laboratory at the Cardiovascular Center (Aalst, Belgium), described in a clinical trial abstract this combination strategy used to treat 12 patients, calling it the first hybrid bypass performed without opening the chest and on a beating heart. He termed the combination approach the best of both worlds.

De Bruyne acknowledged the small number of patients in this pilot study, but said that the technique might be applied to many similar patients. We had absolutely no complications with this approach.

All of the patients involved in the study had presented primarily with angina pain, as well as the other co-morbid conditions, Grievisu Dovidavicus, MD, who worked with De Bruyne on the study, told Cardiovascular Device Update.

The researchers said that larger-trial confirmation could especially benefit patients with more complex problems, such as those with both coronary heart disease and diabetes and patients whose narrowed arteries include chronic obstruction of the left anterior descendant (LAD) artery. In this trial, all had fatty deposits narrowing the hearts three main arteries, including obstructions in the LAD that precluded angioplasty.

Eleven patients were first treated with angioplasty in the right coronary artery or left circumflex artery an average of 41 days prior to their bypass operation. The 12th patient underwent angioplasty three days after surgery. A combination of bare-metal stents and the Taxus stent from Boston Scientific (Natick, Massachusetts) were used, Dovidavicus said.

The keyhole surgery described as robotically enhanced, minimally invasive direct coronary artery bypass [MIDCAB], used in only a few centers worldwide uses a robotic system to harvest from the chest one or both internal mammary arteries.

Doctors then sutured them to the obstructed coronary arteries through a left keyhole mini-thoracotomy, about 2 inches wide, to supply blood below the obstruction.

The harvesting is done by cutting two small holes in the chest, in addition to a larger hole (the mini-thoracotomy). The surgeon inserts a small light into the chest through one hole and a camera through the other.

The computer-controlled surgical instruments are inserted through the larger hole, with the surgeon viewing the procedure on a monitor. Computer control enables reduction in the tremors of the surgeons hand to reduce …