One-stage hybrid coronary revascularization for the treatment of multivessel coronary artery disease— Periprocedural and long-term results from the “HYBRID-COR” feasibility study

Abstract

BackgroundThe constant growth of interest in hybrid coronary artery revascularization (HCR) is apparent. Yet, few studies report outcomes of the one-stage HCR. Consequently, the status of such procedures is not adequately supported in clinical guidelines. The aim of this study was to report the safety, feasibility, and long term-outcomes of the one-stage HCR.Methods and resultsPatients were enrolled in the prospective one-stage hybrid coronary revascularization program (HYBRID-COR). They underwent a one-stage hybrid revascularization procedure while on double antiplatelet therapy (DAPT) with Ticagrelor: endoscopic atraumatic coronary artery bypass grafting (EACAB) for revascularization of the left anterior descending (LAD) artery and percutaneous intervention in non-LAD arteries with contemporary drug-eluting stents. The composite primary endpoint included MACCE (major adverse cardiac and cerebrovascular events: death, myocardial infarction, stroke, and repeated revascularization) in long-term observation. The study cohort consisted of 30 patients (68% male) with stable coronary artery disease (26.7%) and unstable angina (73.3%). Procedural success was 100%. No death, myocardial infarction (MI), or stroke were observed in the perioperative period. One patient (3.3%) required chest revision and blood transfusion due to surgical bleeding. Kidney injury was noted in two patients (6.6%). In a long-term follow-up (median; IQR: 4.25; 2.62–4.69 years), two patients (6.6%) underwent repeated revascularization and one patient (3.3%) died due to MI. The overall primary endpoint rate was 9.9%.ConclusionOne-stage hybrid revascularization, on DAPT, is a feasible, safe, and efficient way of achieving complete revascularization in selected patients. The complication rate is low and acceptable. Further randomized trials are required.

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

“…Other recent trials that compared the results of hybrid, standard CABG, and PCI showed an incomplete revascularization rate of 7.7%, 8.0%, and 5.7% and a restenosis rate of 8.2%, 20.4%, and 5.9%, respectively. The latter despite less residual ischemia at 12 months in the hybrid group (6.4% vs. 6.7% vs. 7.9%, respectively) [21][22][23][24].…”

“…They observed a sternotomy conversion of 6.1%, but no major bleeding complications (2.0%) [20]. More recently, the HYBRID-COR feasibility study based on a concomitant procedure by means of Endoscopic Coronary Artery Bypass (ECAB) and PCI on DAPT in a hybrid operating room on 30 patients showed only one chest revision for bleeding and one death at more than 4 years follow-up [22]. The management of DAPT represents a key point in the hybrid strategy for myocardial revascularization.…”

The choice of coronary revascularization method depending on comorbid pathology

“…С технической точки зрения оба этапа гибридной процедуры ничем не отличаются от операций КШ и ЧКВ, выполняемых по отдельности. Особенностью открытого этапа может быть большой выбор хирургических доступов: от классической стернотомии до альтернативных менее инвазивных доступов, обеспечивающих более быстрый восстановительный период после операции [32].…”

“…Наименее травматичным (но и пока наименее используемым) является тотальное эндоскопическое коронарное шунтирование (TECAB), когда и выделение ЛВГА, и основной этап операции выполняются торакоскопически с использованием платформы DaVinci. Данный метод пока не получил широкого распространения, что связано с высокой стоимостью хирургической платформы а также с хирургической сложностью выполнения основного этапа через манипуляторы, введённые торакоскопически в условиях работающего сердца [32,33].…”