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Clinical results after hybrid coronary revascularization with totally endoscopic coronary surgery
Jade Claessens1,2, Alaaddin Yilmaz3, Camille Awouters3
1Department of Cardiothoracic Surgery, Jessa Hospital, Stadsomvaart 11, Hasselt, Belgium. jade.claessens@uhasselt.be.
Insights
Hybrid coronary revascularization (HCR) shows lower long-term mortality compared to endoscopic coronary artery bypass grafting (Endo-CABG) alone for multivessel coronary artery disease. HCR offers advantages in recovery time and survival, making it a potentially suitable alternative therapy.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Optimal revascularization strategy for multivessel coronary artery disease (MVCAD) remains debated.
- Balancing surgical graft durability against percutaneous coronary intervention (PCI) invasiveness is key.
- Hybrid coronary revascularization (HCR) combines PCI and surgery as a potential alternative.
Purpose of the Study:
- To compare major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality.
- To evaluate outcomes of endoscopic coronary artery bypass grafting (Endo-CABG) versus HCR in MVCAD patients.
Main Methods:
- Single-center retrospective observational study of 347 patients undergoing Endo-CABG.
- 103 patients underwent HCR; propensity score matching created a comparable Endo-CABG alone group.
- Endo-CABG utilized endoscopic ports and a utility port.
Main Results:
- Similar 30-day mortality (0% HCR vs. 1.94% Endo-CABG alone, p=0.155).
- Comparable MACCE rates after a mean follow-up of 1188 days (9.71% HCR vs. 11.65% Endo-CABG alone, p=0.652).
- Significantly lower long-term all-cause mortality in the HCR group (2.91% vs. 11.65%, p=0.002).
Conclusions:
- HCR demonstrates advantages over Endo-CABG alone in reducing all-cause mortality.
- HCR is associated with shorter cross-clamping time, ICU, and hospital stay.
- HCR may be a suitable alternative therapy for patients with MVCAD.
Background:
The optimal revascularization strategy remains uncertain in multivessel coronary artery disease (MVCAD). The durability of the surgical grafts should be weighed against the decreased invasiveness of percutaneous coronary intervention (PCI). Hybrid coronary revascularization (HCR), a combination of PCI and surgery, could be a feasible alternative. This study aimed to investigate the occurrence of major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality after both endoscopic coronary artery bypass grafting (Endo-CABG) and the HCR procedure.
Methods:
In this single-center retrospective observational study, 347 consecutive patients have been subjected to an Endo-CABG procedure, of which 103 underwent HCR between January 2016 and January 2018. A propensity score matching analysis was performed to match 103 Endo-CABG alone patients to the 103 HCR patients. The Endo-CABG procedure was performed through 3 endoscopic ports (5 mm) in the 2nd, 3rd, and 4th intercostal space and a utility port of 3 cm.
Results:
In both the HCR and matched endo-CABG alone group, the 30-day mortality was acceptable (0% in the HCR group and 1.94% in the matched Endo-CABG alone group, p = 0.155). Additionally, the occurrence of MACCE after a mean follow-up of 1188 ± 538 days was similar in both groups (9.71% and 11.65% for the HCR and matched Endo-CABG alone group, respectively, p = 0.652). Still, the long-term all-cause mortality over this period was significantly higher in the matched Endo-CABG alone group (2.91% after the HCR procedure and 11.65% after matched Endo-CABG alone, p = 0.002).
Conclusion:
HCR has some advantages over Endo-CABG alone regarding the all-cause mortality, cross-clamping time, intensive care unit, and hospital length of stay. Therefore, HCR may be a suitable alternative therapy for patients with MVCAD.
