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Nationwide Short-Term and Midterm Clinical Outcome Comparison of Hybrid Coronary Revascularization Versus Off-Pump
Monica Gianoli1, Anne R de Jong1, Ferenc van der Hulst1
1Heart and Lungs Division, Cardiothoracic Department, University Medical Center Utrecht, The Netherlands.
Insights
Hybrid coronary revascularization (HCR) offers comparable short-term and midterm outcomes to off-pump coronary artery bypass (OPCAB) for multivessel coronary artery disease. This suggests HCR is a viable treatment alternative, though long-term effectiveness requires further study.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Minimally Invasive Procedures
Background:
- Hybrid coronary revascularization (HCR) is an emerging minimally invasive option for multivessel coronary artery disease.
- Conventional coronary artery bypass grafting (CABG) techniques are widely used.
- Comparing HCR with traditional methods is crucial for treatment optimization.
Purpose of the Study:
- To compare the clinical outcomes of HCR versus off-pump coronary artery bypass (OPCAB).
- To evaluate short-term and midterm efficacy and safety in patients with multivessel coronary artery disease.
Main Methods:
- Propensity score matching was used to analyze 117 HCR patients and 313 OPCAB patients.
- The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 30 days.
- Secondary endpoints included mortality, myocardial infarction, repeat revascularization, and midterm survival.
Main Results:
- Thirty-day MACCE rates were similar between HCR (5.1%) and OPCAB (4.1%).
- No significant differences were observed in secondary outcomes, midterm survival, or blood transfusion requirements.
- A numerically higher incidence of myocardial infarction and target vessel revascularization was noted in the HCR group but lacked statistical significance.
Conclusions:
- HCR presents comparable short-term and midterm clinical outcomes to OPCAB for multivessel coronary artery disease.
- HCR is a viable alternative treatment option.
- Further research is needed to determine long-term effectiveness and identify optimal patient candidates for HCR.
Objective:
Hybrid coronary revascularization (HCR) has emerged as a minimally invasive alternative to conventional coronary artery bypass techniques for patients with multivessel coronary artery disease. This study aimed to compare the clinical outcomes of HCR versus off-pump coronary artery bypass (OPCAB) in patients with multivessel disease in The Netherlands.
Methods:
This study analyzed 117 HCR patients and 313 OPCAB patients after propensity score matching. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCE) at 30 days after the procedure. Secondary outcomes included mortality, myocardial infarction, repeat revascularization, and ischemic cerebrovascular accidents. Midterm survival and repeat target vessel revascularization (TVR) were evaluated over a median follow-up of 36 months.
Results:
At 30 days, MACCE rates were similar between the HCR group (5.1%) and the OPCAB group (4.1%; P = 0.62). Secondary outcomes were also comparable between the groups. The incidence of myocardial infarction in the HCR group was numerically higher (3.4% vs 1.6%), but this difference was not statistically significant (P = 0.17). Midterm survival rates showed no significant difference between the groups, although numerically the HCR showed a higher rate of TVR (5.1% vs 4.1%, P = 0.62). No significant differences were found in blood transfusion requirements or postoperative hospital stay duration.
Conclusions:
HCR demonstrated comparable short-term and midterm outcomes to OPCAB, suggesting it is a viable alternative for multivessel coronary artery disease treatment. However, further research is necessary to assess long-term effectiveness and to identify specific patient populations who may benefit most from HCR.
