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Published on: March 27, 2018
Clinical outcomes after hybrid coronary revascularization versus off-pump coronary artery bypass: a prospective
Thomas A Vassiliades1, Patrick D Kilgo, John S Douglas
1From the *Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA USA; †Department of Biostatistics and Bioinformatics, Emory University School of Public Health, Atlanta, GA USA; and ‡Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA.
Insights
Hybrid coronary revascularization offers comparable early outcomes and long-term survival to off-pump coronary artery bypass grafting for multivessel coronary artery disease. This minimally invasive approach shows promising results for patients needing complex cardiac procedures.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Multivessel coronary artery disease (CAD) necessitates effective revascularization strategies.
- Hybrid coronary revascularization (HCR) combines minimally invasive surgical and percutaneous techniques.
- Off-pump coronary artery bypass grafting (OPCAB) is a conventional surgical approach.
Purpose of the Study:
- To compare the efficacy and safety of HCR versus OPCAB in patients with multivessel CAD.
- To evaluate early and long-term clinical outcomes, including major adverse cardiac and cerebrovascular events (MACCE) and survival rates.
Main Methods:
- A cohort of 91 patients underwent HCR (minimally invasive LIMA-LAD grafting plus PCI for non-LAD targets).
- Outcomes were compared with 4175 OPCAB patients using logistic and Cox regression analyses.
- Propensity scoring was employed to mitigate selection bias.
Main Results:
- 30-day MACCE rates were 1.1% for HCR and 3.0% for OPCAB (OR = 0.47, P = 0.48).
- Left internal mammary artery (LIMA) patency was high (98.0% FitzGibbon A).
- Three-year survival was similar between groups (HR = 0.44, P = 0.18).
Conclusions:
- HCR may be noninferior to OPCAB for early MACCE and 3-year survival in multivessel CAD.
- HCR demonstrates favorable early safety and graft patency.
- HCR presents a viable alternative for selected patients with multivessel CAD.
Objective:
: Hybrid coronary revascularization is offered as an alternative strategy for patients with multivessel coronary artery disease (CAD). We present our experience and provide a comparative analysis to off-pump coronary artery bypass grafting (OPCAB).
Methods:
: Ninety-one patients with multivessel CAD underwent minimally invasive left internal mammary artery to left anterior descending grafting in combination with percutaneous coronary intervention of nonleft anterior descending targets (HYBRID). The primary end point of this study was major adverse cardiac and cerebrovascular events (MACCE), defined as death, stroke, and nonfatal myocardial infarction. MACCE in the HYBRID group were compared with 4175 contemporaneously performed OPCAB operations by logistic (30-day outcomes) and Cox proportional hazards (long-term survival) regression methods. Propensity scoring was used to adjust for potential selection bias.
Results:
: The 30-day MACCE (death/stroke/nonfatal myocardial infarction) rate was 1.1% for the HYBRID group (0%/0%/1.1%) and 3.0% for the OPCAB group (1.8%/1.1%/0.5%) (odds ratio = 0.47, P = 0.48). Angiographic left internal mammary artery evaluation was obtained in 95.6% of patients (87 of 91) revealing FitzGibbon A patency in 98.0% (96 of 98). The reintervention rate at 1 year for the HYBRID group was 5.5% (5 of 91) and was limited to repeat percutaneous coronary intervention. Three-year survival was statistically similar for the two groups (hazard ratio = 0.44, P = 0.18, see Kaplan-Meier figure).
Conclusions:
: Hybrid coronary revascularization may be noninferior to OPCAB with respect to early MACCE and 3-year survival in the treatment of multivessel CAD.
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