Hybrid
Cardiac Surgery

Hybrid revascularisation is an innovative approach where Dr Bassin will work with an interventional cardiologist to tailor a hybrid treatment for you, which combines less invasive surgical techniques with procedures performed by a cardiologist in the cardiac catheter lab. This collaborative solution means less surgical trauma while still ensuring the best possible outcome for the patient.

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Complex triple vessel coronary disease using hybrid techniques: a single bypass is performed on the most important artery (the LAD) using robotic or minimally invasive techniques and the remaining blockages are treated with coronary stents, avoiding the need for a sternotomy.

What is Hybrid
Surgery?

Hybrid cardiac surgery combines traditional heart surgery and interventional cardiology to facilitate less invasive surgery. These techniques can be used for coronary bypass, mitral valve or aortic valve surgery.

Cardiac or heart surgery is performed by qualified cardiothoracic surgeons in an operating theatre under general anaesthetic. Typical operations include coronary artery bypass grafting (CABG), heart valve repair or replacement and replacement of a diseased aorta.

Coronary stenting is an alternative for narrowed or blocked coronary arteries and is performed by an interventional cardiologist in a cardiac catheter lab, usually without general anaesthesia. A coronary stent is a small scaffold that sits within a narrowed segment of a coronary artery to keep it open. The stent is placed via a small catheter in the wrist (radial artery) or the leg artery (femoral artery). Recovery is rapid and patients can usually go home the same day.

Hybrid cardiac surgery is when a cardiothoracic surgeon will perform minimally invasive heart surgery and then a cardiologist will open one or two coronary blockages with a stent. This means that patients who have coronary and valve disease can still undergo minimally invasive or robotic heart surgery.

What is involved?

Hybrid cardiac surgery involves a combination of minimally invasive or robotic heart surgery and the placement of coronary stents in a separate procedure. The timing of the two procedures depends on a number of factors including how severe the coronary blockages are and how urgent the heart surgery is.

Typically, a patient will undergo minimally invasive heart surgery and then a few days later will have the stents placed by an interventional cardiologist.  Coronary stents require blood thinners including aspirin and clopidogrel which can increase the chance of bleeding during surgery; therefore, it is important to ensure all bleeding has been resolved after the surgery. If a patient has a severely narrowed coronary artery we may place a stent prior to minimally invasive heart surgery. The surgery will then be delayed by 6 weeks or more and the blood thinners reduced just prior to the heart surgery.

The timing and planning of each hybrid procedure is very individualised and Dr Bassin will plan this in conjunction with your cardiologist.  The hospital stay is not prolonged for hybrid surgery and the recovery and trauma is reduced compared to traditional open heart surgery.

Open triple coronary bypass surgery with a sternotomy – a full chest incision for the surgeon to access the heart and bypass all three arteries.

Hybrid Coronary Bypass

There are three main arteries that supply the heart with blood and oxygen and these are called coronary arteries. The most important is the left anterior descending (LAD) which runs along the front of the heart. The next most important is the left circumflex which runs around the left side of the heart. The last is the right coronary artery which runs along the right side and the underneath surface of the heart.

For standard bypass surgery, the LAD is bypassed with the left internal mammary artery (LIMA). This is taken from behind the breastbone (sternum) and attached to the LAD bypassing any blockages to give it a new blood supply. The other coronary arteries are typically bypassed with a vein from the leg (long saphenous vein) or an artery from the arm (radial artery). The LIMA has the best long-term results of any bypass graft and it is this bypass that enables patients to live longer with bypass surgery. Vein bypasses however do not last as long as the LIMA in general and in the right patients, a coronary stent can be as good as or better than a vein bypass.

Combining the best of
surgery and technology.

Hybrid coronary revascularisation consists of minimally invasive or robotic surgery to bypass the LAD in combination with coronary stents to treat the remaining blockages.

 

What is Hybrid Cardiac Surgery?

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Normally for patients with blockages in all three arteries (triple vessel disease) open heart surgery is required with opening the breastbone. However, with hybrid coronary bypass, the most important bypass – the LIMA to LAD – is performed with minimally invasive or robotic surgery and the other blockages are opened with a stent by an interventional cardiologist. This avoids opening the chest and the leg wounds associated with taking the veins out. This means that patients have a more rapid recovery and far smaller wounds than with traditional open heart surgery.

Open aortic valve replacement and single bypass surgery with a sternotomy – a full chest incision for the surgeon to access both the valve and the blocked artery.

Hybrid Aortic Valve Replacement or Mitral Valve Repair

Patients who require valve surgery can usually have this procedure done with a minimally invasive or robotic approach if they don’t have any blocked coronary arteries. However, if the preoperative angiogram shows that there are blockages, usually an open-heart operation is required to perform the coronary bypass surgery at the same time as the valve surgery.

During hybrid valve surgery, minimally invasive or robotic techniques are used to repair or replace the diseased valve and then coronary stents are placed to open the blockages approximately one week after surgery.

Hybrid aortic valve replacement consists of minimally invasive surgery through a small 5cm incision and then a coronary stent inserted through a catheter.

Hybrid valve surgery is suitable for patients requiring valve repair or replacement who have disease in either the circumflex and/or right coronary arteries. If patients have disease in the LAD – the most important coronary artery – sometimes traditional open heart surgery is required to achieve valve repair/replacement and coronary bypass with a LIMA to the LAD simultaneously.

In each case Dr Bassin will discuss the individual circumstances of each patient with the cardiologist to come up with a suitable plan that provides the patient the best possible outcome.

What is the recovery like?

The recovery after hybrid surgery is far more rapid than traditional open heart surgery.  You will recover in hospital for a few days after your surgery until you regain your strength to have the stents placed.  Most patients can go home after 6-7 days.

Once at home, patients who have undergone hybrid surgery continue recovery a lot faster than those who have undergone open heart surgery with splitting of the breastbone. Mobilisation is far easier and there aren’t any restrictions on lifting. Patients are encouraged to take plenty of walks. Your body will let you know what it’s capable of and there is no need to push it. Most patients will feel back to their usual selves after about 4 weeks following a hybrid procedure compared with 3 months following traditional open heart surgery.

YOUR PATIENT JOURNEY

What are the benefits and risks of this procedure?

The risks of hybrid surgery include the same risks of minimally invasive heart surgery as well as the risks of coronary stenting. This is offset by the reduced risks of bleeding, infection and trauma that occurs with open heart surgery.

Dr Bassin will explain these risks to each patient in person and how they pertain to their specific condition.