Hybrid coronary revascularization versus traditional coronary artery bypass grafting for left main coronary artery
Elsa Hebbo1, Madeleine Barker1, Daniel A Gold1
1Emory Clinical Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
Insights
Hybrid coronary revascularization (HCR) is a safe and effective alternative to coronary artery bypass grafting (CABG) for treating left main (LM) disease. HCR showed significantly lower major adverse cardiovascular events and shorter hospital stays compared to CABG.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) is the standard for significant left main (LM) stenosis, particularly with complex disease.
- Hybrid coronary revascularization (HCR) offers a less invasive option, combining robotic bypass with percutaneous coronary intervention for LM disease.
Purpose of the Study:
- To compare clinical outcomes between HCR and CABG in patients with LM disease.
- To evaluate the safety and efficacy of HCR as an alternative revascularization strategy.
Main Methods:
- Retrospective analysis of patients treated for LM disease between 2019-2023.
- Propensity matching used to compare 59 HCR patients with 59 CABG patients.
- Primary outcome: Major Adverse Cardiovascular Events (MACE) at 30 days, 6 months, and 1 year. Secondary outcomes included death, MI, repeat revascularization, and stroke.
Main Results:
- HCR group had significantly shorter hospital stays (4.07 vs 7.58 days).
- MACE rates were significantly lower in the HCR group at 30 days (0% vs 10.2%), 6 months (0% vs 17%), and 1 year (2.4% vs 20.5%).
- Repeat revascularization rates were lower at 6 months for HCR (0% vs 10.9%).
Conclusions:
- HCR is a safe and viable alternative to CABG for LM disease patients.
- Further randomized clinical trials are necessary to validate these findings.
Background:
The current recommended intervention for significant left main (LM) stenosis, especially in patients with complex and high SYNTAX score disease, is coronary artery bypass grafting (CABG). Hybrid coronary revascularization (HCR) combines robotic coronary artery bypass and percutaneous coronary intervention, offering a less invasive approach for patients with LM disease.
Objectives:
We compare clinical outcomes between HCR and CABG in patients with LM disease.
Methods:
We retrospectively screened all patients treated for LM disease between 2019 and 2023 at a single institution. Propensity matching was used for baseline characteristics. The primary outcome was major adverse cardiovascular events (MACE) at 30 days, 6 months and 1 year. Secondary outcomes included death, myocardial infarction, repeat revascularization and stroke.
Results:
Out of a total of 761 patients treated for LM disease, 59 HCR patients were propensity matched to 59 CABG patients and were included in the final analysis. SYNTAX score was >33 for 49.1 % of HCR patients and 67.3 % of CABG patients (p = 0.15). Hospital length of stay was significantly shorter for HCR patients compared to CABG (4.07 days vs. 7.58 days, p < 0.001). MACE were significantly lower in the HCR group at 30 days (0 % vs 10.2 %; p = 0.01), 6 months (0 % vs 17 %; p = 0.002) and 1 year (2.4 % vs 20.5 %; p = 0.01) compared to CABG group. Additionally, there was a lower rate of repeat revascularization at 6 months in the HCR group (0 % vs 10.9 %; p = 0.02).
Conclusions:
This retrospective study demonstrates that HCR is a safe and viable alternative to CABG in patients with LM disease. Randomized clinical trials comparing the two treatment modalities are needed to confirm these findings.
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