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

Abstract

<jats:p>Objectives: Minimally invasive coronary revascularization (MICR) involves minimally invasive direct coronary artery bypass grafting (MIDCAB) and robotic-assisted coronary artery bypass grafting (RCABG), and hybrid coronary revascularization (HCR) aims to combine MICR/RCABG on left anterior descending (LAD) and percutaneous coronary interventions (PCI) on non-LAD lesions. We performed a systematic review and metaanalysis to compare clinical outcome after MICR and HCR.&#x0D; Methods: A metaanalysis was carried out through searching PubMed, EMBASE, Web of Science, and Medline for comparative studies evaluating the primary and secondary clinical end points.&#x0D; Results: A systematic literature search identified 8 observational studies that satisfied our inclusion criteria, including being suitable for metaanalysis; the studies were between 1990 and 2018 and included 1084 cases of HCR and 2349 cases of MICR. Metaanalysis of these studies showed that HCR was associated with a reduced need for ICU LOS (WMD –11.46 hours, 95% CI, –18.76 ~ –4.25, P = .02), to hospital time (WMD –1.34 hours, 95% CI, –2.42 to 0.26, P &lt; .01), and blood transfusion (OR 0.43, 95% CI, 0.31-0.59, P &lt; .00001) than MICR. Comparisons of individual components showed no significant difference in terms of in-hospital mortality, MACCE, shock, myocardial infarction (MI), long-term survival, total variable cost, and surgical complications (including renal failure, chest drainage, bleeding).&#x0D; Conclusions: HCR was noninferior to MICR in terms of in-hospital mortality, MACCE, shock, MI, long-term survival, total variable cost, and surgical complications (including renal failure, chest drainage, bleeding), whereas HCR was associated with a reduced need for ICU LOS, hospital time, and blood transfusion than MICR and less infection than MICR. Further randomized studies are warranted to corroborate these observational data.</jats:p>

Hybrid coronary revascularization versus percutaneous coronary intervention: A systematic review and meta-analysis

“…Before jumping into discussions about comparisons between outcomes of HCR and PCI, we should first ask ourselves if HCR is superior (or at least comparable) to CABG surgery, considered to be the best option for MVD. Two recent meta-analyses [6] , [7] shed some light on this subject. Wang et al [6] conducted a meta-analysis with 23 studies including 10,468 patients (2403 underwent HCR and 8065 patients underwent traditional CABG.…”

“…However, long-term results showed no significant difference between the HCR and CABG techniques. Guan et al [7] performed a systematic review and meta-analysis to compare clinical outcomes after HCR and minimally invasive coronary revascularization (including minimally invasive direct coronary artery bypass grafting and robotic-assisted coronary artery bypass grafting). Their study included 8 observational studies with 1084 cases of HCR and 2349 cases of minimally invasive coronary revascularization.…”

“…Hybrid coronary revascularization (HCR) is an emerging treatment for multivessel coronary artery disease (MVD) which combines the excellent long-term outcomes of coronary artery bypass grafting (CABG) with the early recovery and reduced short-term complications of percutaneous coronary intervention (PCI) [1] , [2] . Previous reports and meta-analyses have demonstrated favorable outcomes, showing lower need for blood transfusion, shorter length of stay, and faster recovery, while maintaining similar rates of major adverse cardiac and cerebrovascular events (MACCE) compared with conventional CABG [3] , [4] , [5] , [6] , [7] .…”

Robotic off-pump hybrid coronary revascularization - a niche area in need for objective data.

“…(2-6) Equally, most of the studies have also confirmed that compared with other techniques of revascularization, HCR is associated with similar 30-day mortality. (2)(3)(4)(5)(6) The evidence on reduction in rates of atrial fibrillation (AF) is not very strong with other studies and meta-analysis reporting no difference in AF rates between HCR and other techniques of revascularization. (4,7) The shorter ICU and overall hospital length of stay reported in this study is also supported by several other studies.…”

“…(4,7) The shorter ICU and overall hospital length of stay reported in this study is also supported by several other studies. (3)(4)(5)(6) However, the definition of what constitutes operative time and hospital length of stay needs further discussion. HCR consists of two distinct procedures -CABG and PCI.…”