Hybrid coronary revascularization versus coronary artery bypass grafting for multivessel coronary artery disease: systematic review and meta-analysis

Abstract

BackgroundThe concept of hybrid coronary revascularization (HCR) combines the left internal mammary artery (LIMA)–left anterior descending (LAD) graft and percutaneous coronary intervention (PCI) to non-LAD vessels. Multiple comparative studies have evaluated the safety and feasibility of HCR and coronary artery bypass grafting (CABG) for multivessel coronary artery disease (MCAD). However, the sample size of each study was small, and evidences based on single-institutional experience. The purpose of this meta-analysis was to compare the short-term outcomes of HCR with those of CABG for MCAD.MethodPubMed, EMBASE and Cochrane Library databases, as well as conference proceedings, were searched for eligible studies published up to March 2014. We calculated summary odds ratios (OR) for primary endpoints (death, stroke; myocardial infarction (MI); target vessel revascularization (TVR); major adverse cardiac or cerebrovascular events (MACCEs)) and secondary endpoints (atrial fibrillation (AF); renal failure; length of stay in the intensive care unit (LoS in ICU); length of stay in hospital (LoS in hospital); red blood cell (RBC) transfusion). Data from 6176 participants were derived from ten cohort studies.ResultsHCR was non-inferior to CABG in terms of MACCEs during hospitalization (odds ratio (OR), 0.68, 95% confidence interval (CI), 0.34–1.33)and at one-year follow-up(0.32, 0.05–1.89) , and no significant difference was found between HCR and CABG groups in in-hospital and one-year follow-up outcomes of death, MI, stroke, the prevalence of AF and renal failure, whereas HCR was associated with a lower requirement of RBC transfusion and shorter LoS in ICU and LoS in hospital than CABG (weighted mean difference (WMD) –1.25, 95% CI, –1.62 to –0.88; –17.47, –31.01 to –3.93; –1.77, –3.07 to –0.46; respectively).ConclusionOur meta-analysis indicates that HCR is feasible, safe and effective for the treatment of MCAD, with similar in-hospital and one-year follow-up outcome, significantly lower requirement of RBC transfusion, and faster recovery compared with CABG.

Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting

“…In another meta-analysis Zhu and colleagues [11] analyzed data from 10 cohort studies involving 6,176 patients. They found that HCR was noninferior to CABG in terms of major adverse cardiac or cerebrovascular events during index hospitalization (odds ratio 0.68, 95% confidence interval: 0.34 to 1.33) and at 1-year follow-up (odds ratio 0.32, 95% confidence interval: 0.05 to 1.89), and no significant difference was found between HCR and CABG groups in the hospital and 1-year follow-up outcomes of death, myocardial infarction, stroke, atrial fibrillation, and renal failure; whereas HCR was associated with a lower requirement of blood transfusion and shorter intensive care unit stay and hospital stay than CABG (weighted mean difference À1.25, 95% confidence interval: À1.62 to À0.88; À17.47 to À31.01; À3.93 to À1.77 and À3.07 to À0.46, respectively).…”

Collaboration between Interventional Cardiologists and Cardiac Surgeons in the Era of Heart Team Approach

“…Zhu et al performed a meta-analysis to compare the short-term outcomes of HCR with those of CABG for multivessel coronary artery disease. They found that HCR was noninferior to CABG in terms of the incidence of death, myocardial infarction, stroke, and renal failure, whereas HCR was associated with less blood transfusion and shorter length of stay in hospital [30]. Halkos et al compared the outcomes of 147 HCR cases with matched off-pump CABG cases.…”

Catheter-Based Educational Experiences: A Canadian Survey of Current Residents and Recent Graduates in Cardiac Surgery

“…Strategies which combine these approaches with surgery in a hybrid format such as with coronary stenting and minimally invasive surgical revascularization have been demonstrated to be cost-effective and may minimize procedural risks 1,2 . Non-surgical interventional approaches for the treatment of valvular diseases have also become popular with heart teams and surgeons have been key players in the roll-out of this technology.…”