More data emerges to suggest that keyhole coronary bypass surgery offers excellent outcomes

Sun 29 April 2018

In a recent study (The Polmides Study Investigators) 200 selected patients were randomised to undergo either traditional coronary bypass surgery thorough a breast bone cut OR hybrid coronary surgery (LIMA to the LAD and stents to other vessels). Traditional surgery involves dividing the breastbone and performing bypass grafts to the diseased arteries. In hybrid keyhole coronary surgery, revascularisation of the LAD (left anterior descending artery) is performed through a small window between the ribs on the left side of the chest, and the remaining blockages are treated using stents placed via a wire in the groin. The rationale is to optimise the results of the treatment whilst avoiding the invasiveness of breaking the breastbone.

The study has clearly shown that there was no long term advantage in undergoing traditional surgery over hybrid keyhole  revascularisation at 5 years. The incidence of dying, having another heart attack, requiring repeat treatment, suffering a stroke or other major cerebrovascular event were no different between the groups suggesting that hybrid keyhole revascularisation performed as well as open breastbone surgery.

Other studies listed below have suggested similar findings with evidence that keyhole treatments are associated with much swifter recovery, with less pain, less bleeding, less infection and rapid discharge from hospital and return to normal activities in days rather than months.

Not all patients are suitable for hybrid keyhole coronary bypass, and each patient requires a detailed clinical review by a team of keyhole heart specialists. 

Further reading:

Hybrid cardiovascular procedures 2008

Advances in Surgical Treatment of Acute and Chronic Coronary Artery Disease 2010

The golden age of minimally invasive cardiothoracic surgery: current and future perspectives 2011

Coronary artery bypass grafting: Part 2—optimizing outcomes and future prospects 2013

Meta-analysis of minimally invasive coronary artery bypass versus drug-eluting stents for isolated left anterior descending coronary artery disease 2014

Hybrid coronary revascularization in selected patients with multi-vessel disease 2018

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