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Published on: March 27, 2018
Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting: Comparative Effectiveness Analysis
Ali Hage1, Vincenzo Giambruno1, Philip Jones2
1Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada.
Insights
Hybrid coronary revascularization (HCR) offers a shorter recovery for selected patients with multivessel coronary artery disease compared to off-pump coronary artery bypass grafting (CABG). Both HCR and CABG demonstrate excellent long-term outcomes, with HCR showing improved survival trends and freedom from angina.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Medical Technology
Background:
- Hybrid coronary revascularization (HCR) combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for multivessel coronary artery disease.
- Off-pump CABG is a conventional surgical approach for treating similar conditions.
Purpose of the Study:
- To compare the long-term outcomes of HCR versus conventional off-pump CABG.
- To evaluate the efficacy and safety of HCR in selected patients.
Main Methods:
- A propensity score analysis using inverse-probability weighting was performed.
- Compared outcomes between 216 off-pump CABG patients and 147 HCR patients (robotic-assisted minimally invasive direct CABG + PCI).
- Follow-up extended to a median of 81 months for CABG and 96 months for HCR.
Main Results:
- HCR demonstrated a shorter hospital length of stay and lower rates of prolonged mechanical ventilation.
- In-hospital reintervention rates were higher in the HCR group (3.4% vs. 0%).
- HCR showed a trend toward improved survival (96% vs. 85%) and significantly better freedom from angina (90% vs. 73%).
Conclusions:
- HCR provides a shorter postoperative recovery in selected patients.
- HCR demonstrates comparable excellent short- and long-term outcomes to off-pump CABG.
- HCR may offer advantages in survival trends and symptom relief for specific patient groups.
Abstract:
Background Hybrid coronary revascularization (HCR) involves the integration of coronary artery bypass grafting (CABG) and percutaneous coronary intervention to treat multivessel coronary artery disease. Our objective was to perform a comparative analysis with long-term follow-up between HCR and conventional off-pump CABG. Methods and Results We compared all double off-pump CABG (n=216) and HCR (n=147; robotic-assisted minimally invasive direct CABG of the left internal thoracic artery to the left anterior descending artery and percutaneous coronary intervention to one of the non-left anterior descending vessels) performed at a single institution between March 2004 and November 2015. To adjust for the selection bias of receiving either off-pump CABG or HCR, we performed a propensity score analysis using inverse-probability weighting. Both groups had similar results in terms of re-exploration for bleeding, perioperative myocardial infarction, stroke, blood transfusion, in-hospital mortality, and intensive care unit length of stay. HCR was associated with a higher in-hospital reintervention rate (CABG 0% versus HCR 3.4%; P=0.03), lower prolonged mechanical ventilation (>24 hours) rate (4% versus 0.7%; P=0.02), and shorter hospital length of stay (8.1±5.8 versus 4.5±2.1 days; P<0.001). After a median follow-up of 81 (48-113) months for the off-pump CABG and 96 (53-115) months for HCR, the HCR group of patients had a trend toward improved survival (85% versus 96%; P=0.054). Freedom from any form of revascularization was similar between the 2 groups (92% versus 91%; P=0.80). Freedom from angina was better in the HCR group (73% versus 90%; P<0.001). Conclusions HCR seems to provide, in selected patients, a shorter postoperative recovery, with similar excellent short- and long-term outcomes when compared with standard off-pump CABG.
