Clinical outcomes of hybrid coronary revascularization versus coronary artery bypass surgery in patients with diabetes mellitus

Harskamp, Ralf E.; Walker, Patrick F.; Alexander, John H.; Xian, Ying; Liberman, Henry; Winter, Robbert J. de; Vassiliades, Thomas A.; Peterson, Eric D.; Puskas, John D.; Halkos, Michael E.

doi:10.1016/j.ahj.2014.06.027

Cited by 27 publications

(23 citation statements)

References 24 publications

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“…Postoperative length-of-stay tended to be shorter after concurrent HCR as well as staged HCR compared with conventional CABG. In a recent meta-analysis [17] including 1190 patients, no significant differences were found for in-hospital major adverse cerebrovascular or cardiac events after HCR when performed as a concurrent (OR: 0.34, P ¼ 0.22) or staged procedure (OR: 0.81, P ¼ 0.70) compared with CABG. Similarly, no differences were found for mortality at 1-year follow-up after concurrent (OR: 0.72, P ¼ 0.78) or staged HCR (OR: 0.63, P ¼ 0.32).…”

Section: Concurrent and Staged Hybrid Proceduresmentioning

confidence: 88%

“…2 OpenMetaAnalyst software was used to perform this meta-analysis, in which a fixed effect model was used applying the MantelÀHaenszel test method. In-criteria and exclusion criteria were similar to those used in a previous meta-analysis of our group on this topic [17], and the literature search was updated until 3 May 2015. A total of seven studies were included for the comparison of HCR versus CABG [16 && ,17-23], in which one study only involved data on long-term all-cause mortality [18].…”

Section: Hybrid Coronary Revascularization Versus Coronary Artery Bypmentioning

confidence: 99%

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Current state and future direction of hybrid coronary revascularization

Harskamp¹

2015

Current Opinion in Cardiology

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Section: Concurrent and Staged Hybrid Proceduresmentioning

confidence: 88%

Section: Hybrid Coronary Revascularization Versus Coronary Artery Bypmentioning

confidence: 99%

Current state and future direction of hybrid coronary revascularization

Harskamp¹

2015

Current Opinion in Cardiology

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“…20 The reported stroke rates were 0% to 1.7%. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] It is notable that despite the anaortic approach used for the HCR CABG arm (mostly in situ LIMA conduit), the stroke rates are not much lower.There are two meta-analyses that evaluate the studies done on HCR and conventional CABG patients (Table 2). 27,28 Phan and Harskamp both showed that there is no benefit for perioperative mortality, stroke, or 1-year freedom from major adverse events when using HCR over CABG.…”

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confidence: 99%

Minimally Invasive Multivessel Coronary Surgery and Hybrid Coronary Revascularization: Can We Routinely Achieve Less Invasive Coronary Surgery?

Rodriguez

Ruel

2016

Methodist DeBakey Cardiovascular Journal

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Editor's Note: We are pleased to offer 1 credit of Continuing Medical Education for successfully completing an online quiz about this article. You may access the quiz at www.houstonmethodist.org/cme-online. AbstractCoronary artery bypass grafting (CABG) is the gold standard in managing severe coronary artery disease. However, it is associated with prolonged recovery and potential complications, in part due to the invasiveness of the procedure. Less invasive CABG techniques attempt to improve the quality and quantity of life in the same way as surgical revascularization but with fewer complications.Minimally invasive coronary surgery (MICS) through a small thoracotomy allows for complete revascularization with good results in graft patency. Perioperative mortality is low, and there is decreased need for blood transfusion, lower surgical site infection rates, and an earlier return to full physical function. Hybrid coronary revascularization (HCR) attempts to combine the advantages of coronary artery bypass grafting with those of percutaneous coronary intervention. Several studies have shown that HCR provides better short-term outcomes with regard to decreased ventilation and ICU time, reduced need for blood transfusion, and shortened hospital stay. However, the rates for major adverse cardiovascular events and mortality are comparable to conventional CABG, except for patients with a high SYNTAX score who displayed increased mortality rates. There is also strong evidence of a higher need for repeat revascularization with HCR compared to CABG.Overall, MICS and HCR appear to be viable alternatives to conventional CABG, offering a less invasive approach to coronary revascularization, which may be especially beneficial to high-risk patients. This article discusses approaches that deliver the advantages of minimally invasive surgical revascularization that can be adapted by surgeons with minimal investment with regards to training and infrastructure.MDCVJ | XII (1) 2016 15 houstonmethodist.org/debakey-journal With MICS-CABG, complete myocardial revascularization is achievable in more than 95% of cases 1 since the technique allows access to the anterior, lateral, and inferior walls of the heart with or without use of CPB. Perioperative mortality is low at 1.3%. 1Other advantages include a decreased need for blood transfusion, lower surgical site infection rates, and earlier return to full physical function.1,3,4 Associated complications include sternotomy conversion and development of left-sided pleural effusion. 1,3,5 Postoperative pain can be an issue during the initial hours, but it is transient, controllable, and significantly reduced by the third postoperative day; it is also associated with an overall improved postoperative pain picture with improved pulmonary functions. 6,7 Notably, unlike sternotomy patients, MICS-CABG patients have no physical restriction postoperatively, which leads to improved independence. Even though MICS-CABG is more technically demanding, its anastomotic patency results were validated to...

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“…HCR was compared to multi-arterial grafting in a retrospective review, where less blood transfusion and a shorter length of stay were noted; 30-day MACCE were similar (17). Other studies have shown faster recovery after surgery (18), with quicker return to work (19) and improved quality of life scores at 3 months (20).…”

Section: Short-term Outcomesmentioning

confidence: 99%

Hybrid coronary revascularization for the treatment of multivessel coronary artery disease

Kayatta

Halkos

Puskas³

2018

Ann. Cardiothorac. Surg.

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Coronary artery disease (CAD) has typically been treated either medically, with percutaneous coronary intervention (PCI), or with coronary artery bypass grafting (CABG). As advances in stent technology and minimally invasive surgery have developed, a third option has emerged: hybrid coronary revascularization (HCR). In HCR, minimally invasive CABG and PCI are both employed to treat a single patient, often during the same hospital stay. Patients appropriate for this technique vary widely, from low-risk patients with low SYNTAX lesions outside the left anterior descending artery (LAD), to high-risk patients with multiple comorbidities who are felt by the heart team to benefit most by avoiding a sternotomy. Across both our experience and other series in the literature, mortality with HCR is around 1%. Hospital length of stay is less than one week, and typically less than after conventional CABG, but longer than with isolated PCI. Return to baseline activity is substantially shorter after minimally invasive CABG compared to conventional CABG due to the avoidance of a sternotomy; deep sternal wound infections are entirely avoided. Mid-term need for repeat revascularization may be higher with HCR, though randomized data are lacking. In conclusion, HCR is an evolving method to treat multivessel CAD with favorable early results in high volume centers, though growth in the field is limited by surgical experience and success with minimally invasive techniques.

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Clinical outcomes of hybrid coronary revascularization versus coronary artery bypass surgery in patients with diabetes mellitus

Cited by 27 publications

References 24 publications

Current state and future direction of hybrid coronary revascularization

Current state and future direction of hybrid coronary revascularization

Minimally Invasive Multivessel Coronary Surgery and Hybrid Coronary Revascularization: Can We Routinely Achieve Less Invasive Coronary Surgery?

Hybrid coronary revascularization for the treatment of multivessel coronary artery disease

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