A two-stage procedure that combines coronary stenting with robotically assisted bypass surgery can minimize complications and get patients back on their feet faster, researchers report.
The surgery does not require splitting the chest. Instead "keyhole" surgery is performed through small incisions between the ribs, speeding recovery. The da Vinci surgical robot assists the cardiac surgeon in re-routing blood around the most critical blockages, while other blockages are treated with percutaneous coronary intervention (PCI), which typically involves both angioplasty and stenting, according to the Society for Cardiovascular Angiography and Interventions. The study's findings were presented at the SCAI 2012 Scientific Sessions in Las Vegas last week.
"The traditional paradigm is you either stent or you perform surgery, but not both. Now there is a third option where you can do both," senior author Robert Poston, M.D., chief of cardiothoracic surgery at the University of Arizona in Tucson, told MedPage Today.
The technique allows cardiologists and surgeons to work on the same patient in one day, although the article notes that requires a facility with a hybrid cath lab designed for both surgery and catheter-based interventions. Although it plans to install a hybrid lab next year, Poston's team for now does the two procedures on consecutive days.
The 32 patients studied averaged 4.3 days in the hospital. After one year they were 16 percent less likely to die or experience major complications than patients treated with conventional bypass surgery, and after one month, 85 percent were able to perform yard work or run a short distance.
Poston told MedPage Today that two of the biggest major complications--sternal infections and stroke--are avoided "almost by definition" of the minimally invasive procedure.
He pointed out, though, that it will require a culture change in which cardiothoracic surgeons and interventional cardiologists work together. Indeed, in agreeing to reimburse for a device called transcatheter aortic valve implantation (TAVI), the Centers for Medicare and Medicaid Services emphasized a multidisciplinary heart team, ThirdAge.com notes.
The hybrid procedure is more expensive, but a faster recovery is appealing to patients.
Sugam Bhatnagar, associate research scientist in cardiothoracic surgery, says the cost is "marginally higher," according to the society announcement.
"We can never look at costs without linking them with benefits. The hybrid program clearly offers benefits in terms of better quality of life and quicker recovery."