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Ten-year outcomes of hybrid coronary revascularization at a single center
Joshua S Newman1, Omar A Jarral2, Michael C Kim3
1Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital/Northwell Health, Manhasset, NY, USA.
Insights
Hybrid coronary revascularization (HCR) outcomes are excellent regardless of whether robotic-assisted minimally-invasive direct coronary artery bypass (MIDCAB) or percutaneous coronary intervention (PCI) is performed first. This finding applies to patients with multi-vessel coronary disease.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Hybrid coronary revascularization (HCR) is a standard treatment for multi-vessel coronary disease.
- Limited data exists on the optimal timing of surgical versus percutaneous coronary intervention (PCI) within HCR.
Purpose of the Study:
- To assess the efficacy of HCR based on the sequence of surgical (robotic-assisted minimally-invasive direct coronary artery bypass - MIDCAB) and percutaneous coronary intervention (PCI) components.
- To compare outcomes between patients undergoing MIDCAB-first versus PCI-first HCR.
Main Methods:
- Retrospective review of a prospectively collected database (2009-2019).
- Analysis of 109 propensity-matched pairs of HCR patients.
- Comparison of outcomes for MIDCAB-first versus PCI-first strategies.
Main Results:
- Thirty-day mortality was low (0.25%).
- Mid-term survival and freedom from major adverse cardiac and cerebrovascular events (MACCE) were similar between MIDCAB-first and PCI-first groups.
- Elevated serum creatinine was an independent predictor of MACCE.
Conclusions:
- HCR demonstrates excellent short- and long-term results in selected multi-vessel coronary disease patients.
- The sequence of MIDCAB or PCI within HCR does not significantly impact outcomes.
- Patient selection remains crucial for successful HCR.
Background:
Hybrid coronary revascularization (HCR) is a well-established technique for treating multi-vessel coronary disease. There remains a paucity of discussion assessing the efficacy of HCR with respect to the timing of the surgical component relative to that of the percutaneous coronary intervention (PCI).
Methods:
A retrospective review was undertaken of our prospectively collected database from January 2009 to December 2019. Of 395 HCR patients analyzed, we examined the outcomes of 109 pairs of propensity-matched patients who either underwent robotic-assisted minimally-invasive direct coronary artery bypass (MIDCAB) first, or who had PCI prior to surgery.
Results:
Thirty-day mortality was 0.25% (1 death) for the entire cohort. Mid-term survival for the total 'MIDCAB-first' group was 94.1% (17 deaths), not significantly different to that for the 'PCI-first' cohort (8 deaths, 92.7%), and this was also statistically comparable after propensity matching. Perioperative morbidity was not different between patient groups. Freedom from major adverse cardiac and cerebrovascular events (MACCE) and the incidence of repeat revascularization was similar between the two groups at up to 11-year follow-up. Elevated serum creatinine independently predicted increased MACCE for all patients, irrespective of the sequence of HCR revascularization employed.
Conclusions:
In appropriately selected patients with multi-vessel coronary disease, HCR is associated with excellent short and longer-term results, irrespective of whether the MIDCAB or PCI procedure is performed first.
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