Comparison of Coronary Artery Bypass Graft-First and Percutaneous Coronary Intervention-First Approaches for 2-Stage Hybrid Coronary Revascularization

Abstract

BackgroundHybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches.MethodsEighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion.ResultsNo significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376).ConclusionThere were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.

Establishing a robotic coronary artery bypass surgery program: a narrative review

“…The high-quality 3D visual feedback from the Da Vinci™ system provides an excellent visual response and indemnification through the visualization of tissue rearrangement and contortion. The administration of robotic technology to CABG also provides a full continuum of advanced technical skills (31)(32)(33)(34)(35)(36)(37)(38)(39)(40). This is due to the surgeon skills and to the lack of tremor movement combined with high-powered and magnified vision of the robot.…”

Hybrid Coronary Revascularization: Perspective Current State After 25 Years of Start

“…This procedure also allows complications to be resolved immediately and avoids the need for two separate procedures. Real-time angiography may be performed after the completion of LIMA anastomosis to assure the quality of the anastomosis and permit revision if needed and the possibility of direct conversion to CABG when PCI fails for a non-LAD lesion [Choi 2017]. Conversely, 1-stage HCR presents the possible disadvantages of a higher risk of bleeding, due to the use of dual antiplatelet therapy and a risk of stent thrombosis due to the inflammatory response to surgery, and its application is limited to large collaborating spaces, referred to as hybrid operating rooms [Choi 2017].…”

“…There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR [Choi 2017]. CABG first is more common, followed by PCI the next day, weeks, or sometimes 1 to 2 months afterward [Lowenstern 2019].…”

Perioperative risk factors for new‐onset postoperative atrial fibrillation among patients after isolated coronary artery bypass grafting: A retrospective study

“…Additionally, the risk factors identified in previous studies have been primarily focused on Western populations who underwent CABG (Gudbjartsson et al, 2020; Higgs et al, 2020; Khan et al, 2019). This implies that there can be differences in CABG guidelines, surgeon preference and ethnicity among countries, postoperative care after surgery and healthcare expenses for CABG (Choi et al, 2017; Deb et al, 2016; Lee et al, 2016; Melly et al, 2018). Moreover, the results from previous studies on new‐onset POAF after CABG have been controversial or inconsistent.…”