Single-stage hybrid coronary revascularization with long-term follow-up†

Objective Hybrid coronary revascularization offers and combines the advantages of both surgical and percutaneous revascularization and eliminates at the same time the disadvantages of both procedures. The objective of this study was to assess graft and stent patency at 6 months, rate of bleeding, intensive care unit and hospital stay, rate of reintervention, and long-term clinical follow-up. Methods From March 2004 to November 2015, a total of 203 patients underwent robotic-assisted minimally invasive direct coronary artery bypass graft of the left internal thoracic artery to the left anterior descending artery and PCI of a non-left anterior descending vessel in a single or two stage, at three different centers. Patients underwent 6-month angiographic follow-up. The mean ± SD clinical follow-up was 77.82 ±41.4 months. Results Successful hybrid coronary revascularization occurred in 196 of the 203 patients. One hundred forty-six patients underwent simultaneous surgical and percutaneous intervention. Nineteen patients underwent PCI before surgery, and 38 patient underwent PCI after surgery. No in-hospital mortality occurred. The mean ± SD ICU stay was 1 ± 1 days and the mean ± SD hospital stay was 5 ± 2 days. Only 13.3% of the patients required a blood transfusion. Six-month angiographic follow-up has been performed in the 95 patients, and it demonstrated a left internal thoracic artery anastomotic patency of 97.9% and stent patency of 92.6%. A total of 77.8 ± 41.4-month clinical follow-up demonstrated 95.1% survival, 92.6% freedom from angina, and 90.7% freedom from any form of coronary revascularization. Conclusions Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes.

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Single-Stage Arthroscopic Cartilage Repair With Gel Scaffold and BMAC

Video Journal of Sports Medicine ◽

10.1177/26350254211008190 ◽

2021 ◽

Vol 1 (3) ◽

pp. 263502542110081

Author(s):

Christian Hwee Yee Heng ◽

Yee Han Dave Lee

Keyword(s):

Cartilage Repair ◽

Collagen Scaffold ◽

Single Stage ◽

Alternative Source ◽

Injectable Scaffolds ◽

Injectable Scaffold ◽

Long Term Follow Up

Background: Injectable scaffold augmentation has been gaining traction as a promising modality for single-stage cartilage repair. It involves the use of a biological scaffold that augments microfracture techniques by aiding in clot stabilization and maturation. The scaffold provides a matrix that helps with mesenchymal stem cell (MSC) retention and encourages differentiation along a chondrogenic lineage. Bone marrow aspirate concentrate (BMAC) has also been proposed as an alternative source of MSCs to microfracture, and it can potentially avoid the pitfalls of microfracture techniques. Indications: Injectable scaffold augmentation to microfracture techniques are recommended in lesions >4 cm, as long-term follow-up has shown increasing failure over time with microfracture alone. Technique Description: We describe a technique of autologous matrix-induced chondrogenesis using CartiFill, a porcine-derived type 1 collagen scaffold, combined with BMAC as a source of MSCs (avoiding the use of microfracture). Results: Injectable scaffold augmentation has been shown in recent studies to lead to better radiological fill, higher quality of histological repair, and better clinical outcomes as compared with microfracture alone. These injectable scaffolds have the versatility to be used on lesions which have traditionally been considered difficult to address, such as vertical or inverted lesions. Moreover, the use of scaffolds allows the repair to be further augmented with BMAC which provides a source of MSCs without the need to perform microfracture and perforate the subchondral bone. Discussion/Conclusion: Scaffold augmentation is a promising technique that improves upon the results of conventional microfracture repair by allowing augmentation with BMAC, as well as giving surgeons the versatility to apply the scaffold on vertical/inverted lesions. BMAC is also a viable alternative source of MSCs for cartilage repair.

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