Hybrid Revascularization for Multivessel Coronary Artery Disease

Gąsior, Mariusz; Zembala, Michael O.; Tajstra, Mateusz; Filipiak‬, Krzysztof J.; Gierlotka, Marek; Hrapkowicz, Tomasz; Hawranek, Michał; Poloński, Lech; Zembala, Marian; Investigators, Pol-Mides Study

doi:10.1016/j.jcin.2014.05.025

Cited by 127 publications

(99 citation statements)

References 17 publications

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“…Due to the difficulty in implementing a randomized controlled study on surgical patients, all except one (Gasior 2014) are observational studies. 11 These newer studies were performed either as a single-or double-staged HCR, and the approach varied from median sternotomy to robot-assisted endoscopic atraumatic CABG with or without CPB assistance. Drug-eluting stents were used in most of the patients.…”

Section: Mics Hcr One-stage Hcr: Cabg-pci Hcr: Pci-cabgmentioning

confidence: 99%

“…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%

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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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Section: Mics Hcr One-stage Hcr: Cabg-pci Hcr: Pci-cabgmentioning

confidence: 99%

mentioning

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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“…The first, the POL-MIDES study, compared HCR to conventional CABG in 200 patients (22). In this study, no significant differences were seen in death, myocardial infarction, stroke, major bleeding, or repeat revascularization at 1-year (MACCE 11% vs. 8%).…”

Section: Randomized Datamentioning

confidence: 91%

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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“…El primer estudio prospectivo y aleatorizado sobre RMH fue publicado por Gasior et al, en 2014 23 . Los autores hacían hincapié en las limitaciones de la CRM convencional y los resultados no satisfactorios a largo plazo de los injertos venosos para justificar la aleatorización a CRM o RMH.…”

Section: Los Estudiosunclassified

¿Qué nos aporta la cirugía híbrida de revascularización miocárdica?

Mestres

2016

Rev Chil Cardiol

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Hybrid Revascularization for Multivessel Coronary Artery Disease

Abstract: HCR is feasible in select patients with MVCAD referred for conventional CABG. (Safety and Efficacy Study of Hybrid Revascularization in Multivessel Coronary Artery Disease [POL-MIDES]; NCT01035567).

Cited by 127 publications

References 17 publications

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

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

¿Qué nos aporta la cirugía híbrida de revascularización miocárdica?

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