Generalized hybrid coronary revascularization vs. conventional off-pump coronary artery bypass grafting for
Shuai Zhang1,2, Ping Li1,2, Guang Li1,2
1Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Generalized hybrid coronary revascularization (HCR) showed similar midterm outcomes to off-pump coronary artery bypass (OPCABG) in multivessel coronary artery disease. This approach offers a safe and effective alternative with reduced need for intra-aortic balloon pump support and shorter hospital stays.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Hybrid coronary revascularization (HCR) is a proven strategy for multivessel coronary artery disease but has strict inclusion criteria.
- Generalized HCR aims to broaden its applicability.
Purpose of the Study:
- To compare in-hospital and midterm outcomes of generalized HCR versus off-pump coronary artery bypass (OPCABG).
- To evaluate the safety and efficacy of a generalized HCR approach in patients with multivessel coronary artery disease.
Main Methods:
- A propensity score-matched study comparing 111 patients undergoing generalized HCR with 111 patients undergoing OPCABG.
- Generalized HCR involved PCI for suitable non-LAD vessels and MICS-CABG for LAD and other non-stentable vessels.
- Primary endpoint was major adverse cardiac or cerebrovascular events (MACCE); secondary endpoints included in-hospital outcomes.
Main Results:
- No significant difference in midterm MACCE rates between generalized HCR and OPCABG groups (9.9% vs. 16.2%).
- Similar residual SYNTAX scores between the two groups, indicating comparable revascularization completeness.
- Generalized HCR was associated with significantly lower intra-aortic balloon pump (IABP) implantation rates and shorter postoperative length of stay.
Conclusions:
- Generalized HCR is a safe and effective revascularization strategy for multivessel coronary artery disease.
- Outcomes are comparable to standard OPCABG, with satisfactory revascularization.
- The generalized approach may reduce complications and shorten hospital stays.
Background:
Hybrid coronary revascularization (HCR) has been demonstrated as a safe and effective revascularization strategy in selected patients with multivessel coronary artery disease; however, the inclusion criteria are too strict.
Objectives:
This study was conducted to compare in-hospital and midterm outcomes after generalized HCR and off-pump coronary artery bypass (OPCABG) in patients with multivessel coronary artery disease.
Methods:
We proposed a generalized idea of HCR. First, the PCI for non-LAD vessels suitable for coronary stents was performed. Then, MICS-CABG for LIMA to the LAD and saphenous to other non-LAD vessels that were not suitable for stents or stenting failed. Propensity score matching was used, and 222 patients (n = 111 in both the generalized HCR and OPCABG groups) were enrolled in the study. The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE) over midterm follow-up, and the secondary endpoints were in-hospital outcomes.
Results:
No significant difference was observed in the cumulative rate of MACCE (9.9% vs. 16.2%; HR, 0.567; 95% CL, 0.268-1.201; P = 0.138) between the generalized HCR and OPCABG groups. The residual SYNTAX score was similar between two groups (6.3 ± 5.5 for generalized HCR vs. 6.8 ± 5.3 for OPCABG; P = 0.486). Compared with OPCABG, generalized HCR was associated with a significantly lower intra-aortic balloon pump (IABP) implantation rate (2.7% vs. 9.9%; P = 0.027) and shorter postoperative length of stay (6.3 ± 3.2 vs. 7.7 ± 3.0; P = 0.001).
Conclusions:
The generalized HCR procedure appears to be safe and efficacious, with outcomes similar to those of standard off-pump CABG and satisfactory completeness of revascularization.
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