Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta‐analysis of 14 studies comprising 4226 patients

Abstract

Objectives To compare the outcomes of hybrid coronary revascularization (HCR) with traditional coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD). Background HCR has emerged as an alternative to CABG in patients with MVCAD. Through minimally invasive surgical techniques, HCR carries the potential for faster recovery postoperatively, fewer complications, and lower utilization of resources. Methods Systematic search of electronic databases was conducted up to December 2021 and studies comparing HCR with CABG in the treatment of MVCAD were included in this meta‐analysis. Primary outcomes of interest were incidence of 5‐year mortality and major adverse cardiac and cerebral event (MACCE). Results Fourteen studies (12 observational studies and 2 randomized controlled trials) comprising 4226 patients were included. The rates of 5‐year mortality (odds ratios [OR]: 1.55; 95% confidence interval [CI]: 0.92−2.62; I2 = 83.0%) and long‐term MACCE (OR: 0.97; 95% CI: 0.47−2.01; I2 = 74.7%) were comparable between HCR and CABG groups. HCR was associated with a significantly lower likelihood of perioperative blood transfusion (OR: 0.36; 95% CI: 0.25−0.51; I2 = 55.9%), shorter mean hospital stay (weighted mean difference: −2.04; 95% CI: −2.60 to −1.47; I2 = 54%), and risk of postoperative acute kidney injury (OR: 0.45; 95% CI: 0.23−0.88; p = 0.02). CABG demonstrated a lower likelihood of requiring long‐term repeat revascularization (OR: 1.51; 95% CI: 1.03−2.20; I2 = 18%) over a follow‐up duration of 29.14 ± 21.75 months. Conclusion This meta‐analysis suggests that HCR is feasible and safe for the treatment of MVCAD. However, benefits of HCR should be carefully weighed against the increased long‐term risk of repeat‐revascularization when selecting patients, and further studies evaluating differences in long‐term mortality between HCR and CABG are required.

Minimally Invasive Isolated and Hybrid Surgical Revascularization for Multivessel Coronary Disease: A Single-Center Long-Term Follow-Up

“…An ongoing multicenter randomized trial will confirm the quality of life and recovery between MIDCAB and standard sternotomy CABG the MIST Trial [25]. This study will eventually corroborate the very good outcomes of Mid-CAB in the long term (more than 20 years) when performed in a carefully selected patient population [26][27][28]. Robotic iterations of this operation are already performed in leading centers worldwide, aiming to establish the maximal level of a true minimally invasive approach and providing good long-term outcomes in patients who are not candidates for conventional CABG [29].…”

Minimal-Access Coronary Revascularization: Past, Present, and Future

“…Guan et al in 2019 [ 29 ] published a meta-analysis comparing other modalities of minimal-access CABG with HCR, which summarised eight observational studies and concluded that HCR was non-inferior to other modalities of minimal-access CABG, in terms of in-hospital mortality, rates of MACCE, shock, perioperative MI, long-term survival, cost, and surgical complications. On the other hand, Nagraj et al in 2022 concluded in their meta-analysis of twelve observational studies and two RCTs comparing HCR to conventional CABG via a median sternotomy in multivessel coronary artery disease that although feasible, HCR did not have any clear benefits over conventional surgery [ 68 ].…”