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Do beating heart techniques applied to combined valve and graft operations reduce myocardial damage?
John C Y Lu1, Matthew Shaw, Antony D Grayson
1Department of Cardiothoracic Surgery, The Cardiothoracic Centre Liverpool, UK.
Insights
Combined beating heart coronary artery bypass grafting (CABG) and valve surgery showed reduced cardiac enzyme release compared to conventional surgery. This hybrid approach offers a promising alternative for cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) and valve surgery are common cardiac procedures.
- Conventional CABG and valve surgery involve significant myocardial trauma.
Purpose of the Study:
- To compare the outcomes of combined beating heart CABG and valve surgery (hybrid) versus conventional CABG and valve surgery.
- To evaluate cardiac enzyme release, mortality, and survival rates between the two surgical approaches.
Main Methods:
- Prospective data collection on patient characteristics and cardiac enzyme release.
- Logistic regression to develop a propensity score for hybrid group membership.
- Propensity-matched analysis to compare outcomes between hybrid and conventional groups.
Main Results:
- Hybrid CABG and valve surgery demonstrated significantly lower post-operative CK-MB levels (29.5 U/I vs. 44 U/I).
- No statistically significant difference in in-hospital mortality (6.1% vs. 9.8%) or 5-year survival (71% vs. 74%) was observed.
- Matched groups had similar logistic EuroSCORE and median number of grafts per patient.
Conclusions:
- Hybrid beating heart CABG and valve surgery is associated with reduced cardiac enzyme release compared to conventional surgery.
- The hybrid approach appears to be a safe and effective alternative, with comparable mortality and survival rates.
- Further research may explore long-term benefits and patient selection for hybrid cardiac procedures.
Abstract:
We examined the outcomes of combined beating heart CABG and valve surgery (hybrid) and compared these to conventional CABG and valve surgery (conventional). Between April 1997 and March 2006, 388 patients received combined CABG and valve surgery. Patient characteristics and cardiac enzyme release were collected prospectively. To account for differences in case-mix we used logistic regression to develop a propensity score for hybrid group membership and then performed a propensity-matched analysis. One hundred and forty patients underwent hybrid operation with a mean logistic EuroSCORE of 13.5%, compared to 248 who underwent conventional operation with a mean logistic EuroSCORE of 10.9% (P=0.006). Eighty-two patients from each group were successfully matched. The mean logistic EuroSCORE after matching was similar between the groups (11.3% vs. 12.9%; P=0.48). The median number of grafts per patient was also similar, three in each group (P=0.98). Post-op CK-MB levels were found to be significantly lower for hybrid patients (44 U/I vs. 29.5 U/I; P=0.037). In-hospital mortality was not statistically different (9.8% vs. 6.1%; P=0.39). Survival at 5 years was 74% for hybrid and 71% for conventional group (P=0.92). CK-MB levels in patients receiving hybrid CABG and valve surgery are reduced compared to conventional CABG and valve surgery.
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