Staged Hybrid Revascularization in an Octogenarian Male with Chronic Kidney Disease and Three-vessel Coronary Artery Disease with Left Main Coronary Artery Involvement

Ischemic heart disease is a major cause of death in nonagenarians. These patients frequently present with comorbid conditions, including chronic kidney disease, increasing the complexity of the treatment. Both percutaneous coronary intervention and coronary artery bypass graft surgery are therapeutic options with different advantages and disadvantages. We herein report an experience of treating an octogenarian gentleman with three-vessel coronary artery disease involving the left main coronary artery, in whom the coronary lesion and deteriorated renal function were high risk factors for transcatheter intervention. We planned and performed a staged hybrid strategy: first, off-pump minimally-invasive coronary artery bypass surgery for the left anterior descending artery, and second, 2 months later, a transcatheter intervention for the left main coronary artery and left circumflex artery. We achieved complete relief of symptoms and prevented the deterioration of the patient's renal function. We reviewed the advantage of this modality and its impact on renal function.