Ten-Year Outcomes of Off-Pump Coronary Revascularization Using Bilateral Internal Mammary Arteries versus Hybrid
Ibrahim Gadelkarim1,2, Jagdip Kang1, Philipp Kiefer1
1University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
Background:
The study compared long-term outcomes between off-pump coronary artery bypass grafting (OPCAB) using bilateral internal mammary arteries (BIMA) and hybrid coronary revascularization (HCR).
Methods:
We included patients who underwent OPCAB with BIMA (2002-2012) and HCR (2002-2020). Emergency procedures, patients in critical preoperative condition, and on-pump surgery cases were excluded. Propensity score matching with a 2:1 ratio was performed to minimize confounding factors. The primary outcome was 10-year survival.
Results:
Of 687 patients, 552 patients underwent OPCAB with BIMA, and 135 patients received HCR. In-hospital mortality was comparable between groups (BIMA: 1.1% vs. HCR: 3.0%, p = 0.11). The HCR group had higher rates of incomplete revascularization (27.2% vs. 15.2%, p = 0.001) and revision for bleeding (6.7% vs. 1.8%, p = 0.005). After propensity score matching, 10-year survival (BIMA: 71.2% vs. HCR: 69.7%, p = 0.81) was similar between groups, while freedom from repeat revascularization was higher in the BIMA group (89.7% vs. 76.3%, p = 0.003).
Conclusion:
Complete surgical revascularization using BIMA should be preferred when feasible. However, HCR offers comparable survival and represents a viable option for select patients.
