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Robotic Totally Endoscopic Reverse Hybrid Coronary Revascularization: Early and Midterm Outcomes
Yazan N AlJamal1, Sarah Nisivaco2, Riya Bhasin2
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
Insights
Reverse hybrid coronary revascularization (RHCR), combining percutaneous coronary intervention (PCI) and robotic totally endoscopic coronary artery bypass (TECAB), is safe and effective for multivessel coronary artery disease. This approach shows excellent early and midterm outcomes in selected patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Minimally Invasive Cardiac Surgery
Background:
- Multivessel coronary artery disease (CAD) often requires complex revascularization strategies.
- Reverse hybrid coronary revascularization (RHCR) integrates percutaneous coronary intervention (PCI) with coronary artery bypass grafting (CABG).
- Robotic totally endoscopic coronary artery bypass (TECAB) offers a sternal-sparing approach to CABG.
Purpose of the Study:
- To review the institutional experience with RHCR over a 10-year period.
- To evaluate outcomes of RHCR using PCI followed by robotic TECAB.
- To assess the safety and feasibility of this integrated revascularization strategy.
Main Methods:
- Retrospective review of patients undergoing RHCR (PCI with drug-eluting stents followed by robotic TECAB).
- Analysis of patient demographics, procedural details, and clinical outcomes.
- Evaluation of short-term and midterm results, including major adverse cardiac and cerebrovascular events.
Main Results:
- 60 patients underwent RHCR between July 2013 and August 2024.
- Mean age was 66.7 years; 74% were male.
- No conversions, perioperative strokes, or myocardial infarctions occurred. 93% freedom from major adverse cardiac or cerebrovascular events at mean 34-month follow-up.
Conclusions:
- RHCR is a safe and feasible option for select patients with multivessel CAD.
- Stenting followed by robotic TECAB, utilizing internal thoracic artery grafts, yields excellent early and midterm outcomes.
- Further research is recommended to validate these findings.
Objective:
Reverse hybrid coronary revascularization (RHCR) is the integration of percutaneous coronary intervention (PCI) followed by sternal-sparing coronary artery bypass grafting in patients with multivessel coronary artery disease (CAD). We sought to review our RHCR experience over a 10-year period using PCI first followed by robotic totally endoscopic coronary artery bypass (TECAB).
Methods:
We reviewed the indications and outcomes in patients who underwent RHCR (PCI with drug-eluting stents first, followed by TECAB).
Results:
From July 2013 to August 2024, 882 robotic TECAB procedures were performed at our institution. Of these, 60 patients underwent RHCR. The mean age of the patients was 66.7 ± 10 years, and 74% were male patients. The target vessel stented was the right coronary artery in 52 patients (87%), circumflex coronary artery in 10 patients (17%), and diagonal in 4 patients (7%). The average time from PCI to TECAB was 3.8 ± 1.64 months. A total of 35 patients (58%) underwent multivessel grafting, with 74% bilateral internal thoracic artery (ITA) use. The mean operative time was 253 ± 88 min, and the mean hospital length of stay was 2 ± 0.76 days. There were no conversions, perioperative strokes, or myocardial infarctions. At mean follow-up of 34 ± 27 months, cardiac-related mortality occurred in 1 patient. Freedom from major adverse cardiac or cerebrovascular events including repeat revascularization was 93%.
Conclusions:
RHCR is safe and feasible in selected patients with multivessel CAD. In experienced hands, stenting first followed by robotic TECAB with left ITA or bilateral ITA grafts resulted in excellent early and midterm outcomes. Further studies are warranted.
