Mid-term follow-up outcomes of 2-staged hybrid coronary revascularization compared with off-pump coronary artery bypass for patients with multivessel coronary artery disease.

Abstract

IntroductionTwo-staged hybrid coronary revascularization (HCR) is a novel procedure in selected patients with multivessel coronary artery disease. However, few studies are available on the mid-term or long-term outcomes of this 2-staged procedure as compared to off-pump coronary artery bypass (OPCAB).AimTo compare in-hospital and mid-term follow-up outcomes of 2-staged HCR with OPCAB in patients with multivessel coronary artery disease.Material and methodsThe present retrospective study analyzed the data from 73 patients who underwent the 2-staged HCR (HCR group) during 2012–2014 at the heart center. Three hundred and eighty-three patients who underwent conventional OPCAB by the same surgeon were selected for the comparative analysis performed on in-hospital and mid-term follow-up outcomes between the two groups.ResultsNo significant difference was observed in the preoperative outcome between the two groups. The HCR group had a shorter operation duration (152.9 ±43.8 vs. 262.6 ±51.8 min, p < 0.05), less bleeding (558.6 ±441.3 vs. 1035.5 ±613.3 ml, p < 0.05), shorter mechanical ventilation (9.4 ±7.4 vs. 19.0 ±18.3 h, p < 0.05), and less blood transfusion (12 (16.4%) vs. 200 (52.2%), p < 0.05). The mean follow-up duration was 25.0 ±9.6 months in the HCR group and 22.8 ±10.6 months in the OPCAB group. The incidence of major adverse cardiac or cerebrovascular events (MACCE) was similar in both groups (4 (5.5%) vs. 10 (2.8%), p = 0.408). The estimated 3-year survival was similar in both groups (log-rank χ2 = 1.041, p = 0.308).ConclusionsThe 2-staged HCR is a safe and effective surgical procedure and may offer similar mid-term follow-up outcomes to OPCAB.

Randomized Clinical Trial of Surgical vs. Percutaneous vs. Hybrid Revascularization in Multivessel Coronary Artery Disease: Residual Myocardial Ischemia and Clinical Outcomes at One Year—Hybrid coronary REvascularization Versus Stenting or Surgery (HREVS)

“…Prior work indicated that MIDCAB, when compared to conventional sternotomy CABG, results in less surgical trauma, decreased risk of bleeding and infectious complications, and may shorten the length of hospitalization [4,11,12]. e latter, however, is not supported by our findings, a result that may be partly driven (note ITT analysis) by the conversion rate (9.8%) from HCR to CABG in HREVS (Table 2).…”

“…e optimal revascularization approach would thus need to combine a decreased invasiveness plus low risk of perioperative complications and an increased durability and survival. A combination of a minimally invasive LIMA-LAD graft procedure with PCI using DES to non-LAD vessels eliminates aortic manipulation and extracorporeal circulation, resulting in a potential to decrease the risk of perioperative complications [1,4,11,12,17]. us, the "third" revascularization strategy-HCR-might have potential advantages beyond PCI and CABG alone [1, 4-12, 18, 19].…”

“…HCR is defined as a planned intervention combining cardiac surgery with a catheter-based intervention performed within a predefined time [2,4]. HCR employing a combination of a minimally invasive LIMA-LAD graft procedure with PCI using DES to non-LAD vessels is receiving increasing attention [10][11][12] but it has not yet been evaluated in a clinical trial involving the two leading MV-CAD revascularization modalities, CABG and PCI [1].…”

Minimally Invasive CABG or Hybrid Coronary Revascularization for Multivessel Coronary Diseases: Which Is Best? A Systematic Review and Metaanalysis

“…However, these costs may be share out by long hospital stay costs and improved surgery complications cost compared with conventional CABG. But for MICR, the lower surgery complications may lead to a decrease in total cost similar to HCR [Wu 2017].…”

Simulation Training in Minimally Invasive Direct Coronary Artery Bypass Grafting

“…The satisfactory results encouraged us to adopt the technique of MIDCAB in 2012. From February 2012 to November 2019, a total of 620 CABG cases underwent MIDCAB procedures in our center [Zhang 2016;Wu 2017]. Despite the safety and efficacy, MIDCAB did not become a standard procedure for several reasons, mainly due to the technically demanding nature.…”