Robotically assisted hybrid coronary revascularization: does sequence of intervention matter?

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Interventional Cardiology

Background:

• Hybrid coronary revascularization (HCR) combines minimally invasive surgery and percutaneous coronary intervention (PCI) for multivessel coronary disease.
• The optimal sequence for HCR procedures remains undetermined.
• Robotically assisted totally endoscopic coronary artery bypass (TECAB) is a surgical component of HCR.

Purpose of the Study:

• To investigate clinical outcomes based on the revascularization sequence in patients undergoing HCR.
• To compare outcomes between TECAB-first, PCI-first, and same-session HCR procedures.

Main Methods:

• An observational study of 238 patients planned for HCR between 2001 and 2011.
• Patients were grouped by revascularization sequence: TECAB before PCI, PCI before TECAB, or same-session.
• Clinical endpoints and procedural outcomes were compared up to 2 years post-procedure.

Main Results:

• 73.5% underwent TECAB before PCI, 16.0% PCI before TECAB, and 10.5% same-session.
• The PCI-first group had a higher incidence of previous myocardial infarction.
• Simultaneous revascularization was associated with shorter ICU length of stay (LOS), and PCI-first with shorter overall hospital LOS.

Conclusions:

• Revascularization sequence did not dramatically impact overall clinical outcomes in this observational study.
• PCI-first and same-session approaches resulted in shorter hospital and ICU LOS compared to surgery-first.
• Individualized HCR sequencing based on patient factors and anatomy is recommended.