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Comparison of Surgical Outcomes and Long-Term Follow-Up in One-Stage Versus Two-Stage Hybrid Coronary
Magdalena Synak1, Justyna Jankowska-Sanetra2, Wiktoria Stankiewicz1
1Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Poland.
Insights
Hybrid coronary revascularization (HCR) with initial angioplasty (PCI-first) shows better short-term outcomes than one-stage HCR. This approach reduces drainage, ventilation time, and transfusions, though long-term results are similar.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Hybrid coronary revascularization (HCR) combines surgical and percutaneous approaches for complete coronary artery revascularization.
- Comparing one-stage versus two-stage HCR strategies is crucial for optimizing patient outcomes.
Purpose of the Study:
- To compare perioperative outcomes between one-stage and two-stage HCR strategies.
- To evaluate the impact of initial percutaneous coronary intervention (PCI) in a two-stage HCR approach.
Main Methods:
- Retrospective subanalysis of the HYBRID-COR feasibility study.
- Comparison of 30 patients undergoing one-stage HCR (endoscopic atraumatic coronary artery bypass grafting [EACAB] + PCI) versus 121 patients undergoing EACAB as the final stage of HCR.
- Assessment of bleeding, transfusion needs, kidney injury, and other complications; long-term outcomes were also evaluated.
Main Results:
- One-stage HCR showed significantly higher perioperative drainage, longer mechanical ventilation time, and increased rates of pleurocentesis and blood transfusions compared to PCI-first HCR.
- No significant differences were observed in kidney injury incidence between the groups.
- Long-term follow-up revealed no significant differences in major adverse cardiac and cerebrovascular events, mortality, myocardial infarction, repeat revascularization, or stroke.
Conclusions:
- PCI-first HCR is associated with improved short-term perioperative outcomes, including reduced drainage, ventilation time, and transfusion requirements.
- Individualized strategy selection by the heart team is essential, considering risks like postponed revascularization and antiplatelet therapy withdrawal.
- Further research is needed, especially regarding long-term outcomes of different HCR strategies.
Objective:
To compare perioperative outcomes in patients who receive complete revascularization in one-stage or two-stage hybrid coronary revascularization (HCR) with initial angioplasty.
Methods:
The research is a retrospective subanalysis of the HYBRID-COR feasibility study. Thirty patients who underwent one-stage HCR (endoscopic atraumatic coronary artery bypass grafting [EACAB] and percutaneous coronary intervention [PCI]; group 1) were compared with 121 patients who underwent EACAB procedure as a final stage of HCR (group 2). Observations of bleeding, transfusion requirements, kidney injury, and other complications were conducted. Long-term outcomes were evaluated.
Results:
Median (interquartile range [IQR]) perioperative drainage was higher in group 1 (750.0 [422.5 to 1,112.5] mL vs 400.0 [252.5 to 650.0] mL, P = 0.004), as was mechanical ventilation time (430.0 [300.0 to 600.0] min vs 300.0 [225.0 to 410.0] min, P = 0.001). Patients in group 1 required pleurocentesis more often (36.7% vs 13.2%, P = 0.003), as well as blood transfusions (26.7% vs 9%, P = 0.009). No significant differences were found for kidney injury incidence (20% vs 14.9%, P = 0.493). Two deaths (1.6%) and 1 myocardial infarction (0.8%) were noted in group 2 in the perioperative period. In a median long-term follow-up of 1,378.5 (758.0 to 2,033.0) days, no significant differences were noted in major adverse cardiac and cerebrovascular events, mortality, myocardial infarction occurrence, repeat revascularization, or incidence of stroke.
Conclusions:
PCI-first HCR is associated with less postoperative drainage, shorter mechanical ventilation time, fewer pleurocenteses, and less transfusion requirements when compared with one-stage HCR. The heart team decision is essential in choosing individual strategy, as the risk of postponing complete revascularization and temporary dual antiplatelet therapy withdrawal must be evaluated. Further studies are required, particularly on long-term outcomes.
