Background Hybrid coronary revascularization ( HCR ) involves the integration of coronary artery bypass grafting ( CABG ) and percutaneous coronary intervention to treat multivessel coronary artery disease. Our objective was to perform a comparative analysis with long‐term follow‐up between HCR and conventional off‐pump CABG . Methods and Results We compared all double off‐pump CABG (n=216) and HCR (n=147; robotic‐assisted minimally invasive direct CABG of the left internal thoracic artery to the left anterior descending artery and percutaneous coronary intervention to one of the non–left anterior descending vessels) performed at a single institution between March 2004 and November 2015. To adjust for the selection bias of receiving either off‐pump CABG or HCR , we performed a propensity score analysis using inverse‐probability weighting. Both groups had similar results in terms of re‐exploration for bleeding, perioperative myocardial infarction, stroke, blood transfusion, in‐hospital mortality, and intensive care unit length of stay. HCR was associated with a higher in‐hospital reintervention rate ( CABG 0% versus HCR 3.4%; P =0.03), lower prolonged mechanical ventilation (>24 hours) rate (4% versus 0.7%; P =0.02), and shorter hospital length of stay (8.1±5.8  versus 4.5±2.1 days; P <0.001). After a median follow‐up of 81 (48–113) months for the off‐pump CABG and 96 (53–115) months for HCR , the HCR group of patients had a trend toward improved survival (85% versus 96%; P =0.054). Freedom from any form of revascularization was similar between the 2 groups (92% versus 91%; P =0.80). Freedom from angina was better in the HCR group (73% versus 90%; P <0.001). Conclusions HCR seems to provide, in selected patients, a shorter postoperative recovery, with similar excellent short‐ and long‐term outcomes when compared with standard off‐pump CABG .

Purpose In this work we performed an imaged-based computational study of the systolic fluid dynamics in presence of mitral valve regurgitation (MVR). In particular, we compared healthy and different regurgitant scenarios with the aim of quantifying different hemodynamic quantities. Methods We performed computational fluid dynamic (CFD) simulations in the left ventricle, left atrium and aortic root, with a resistive immersed method, a turbulence model, and with imposed systolic wall motion reconstructed from Cine-MRI images, which allowed us to segment also the mitral valve. For the regurgitant scenarios we considered an increase of the heart rate and a dilation of the left ventricle. Results Our results highlighted that MVR gave rise to regurgitant jets through the mitral orifice impinging against the atrial walls and scratching against the mitral valve leading to high values of wall shear stresses (WSSs) with respect to the healthy case. Conclusion CFD with prescribed wall motion and immersed mitral valve revealed to be an effective tool to quantitatively describe hemodynamics in case of MVR and to compare different regurgitant scenarios. Our findings highlighted in particular the presence of transition to turbulence in the atrium and allowed us to quantify some important cardiac indices such as cardiac output and WSS.

Robot-assisted coronary artery bypass grafting is safe, feasible and it seems to represent an effective alternative to traditional coronary artery bypass grafting in selected patients.