Original article
Adult cardiac
Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting

Presented at the Fifty-third Annual Meeting of The Society of Thoracic Surgeons, Houston, TX, Jan 21–25, 2017.
https://doi.org/10.1016/j.athoracsur.2017.11.019Get rights and content

Background

Hybrid coronary revascularization (HCR) is an evolving coronary revascularization strategy for the treatment of multivessel coronary artery disease. We provide a comparative analysis to conventional on-pump coronary artery bypass graft surgery (CABG) with long-term follow-up.

Methods

We included all double on-pump CABG (n = 682) and HCR (147 robotic-assisted minimally invasive bypass grafts of the left internal thoracic artery to the left anterior descending coronary artery and percutaneous coronary intervention to one of the non-left anterior descending coronary artery vessels) performed in our institution between March 2004 and November 2015. We performed an adjusted analysis using inverse-probability weighting based on the propensity score of receiving either on-pump CABG or HCR.

Results

In the adjusted analysis, there was no statistically significant difference in the incidence of reexploration for bleeding, perioperative myocardial infarction, stroke, need for hemodialysis, blood transfusion rate, prolonged mechanical ventilation, and intensive care unit length of stay. Hybrid coronary revascularization was associated with lower inhospital mortality (CABG 1.3%, HCR 0%, p = 0.008), and shorter mean (± SD) hospital length of stay (CABG 6.7 ± 4.7 days, HCR 4.5 ± 2.1 days, p < 0.001). After a median follow-up period of 70 months (range, 37 to 106) for the CABG group and 96 months (range, 53 to 114) for the HCR group, there was no significant difference in survival (CABG 92%, HCR 97%, p = 0.13) or freedom from any form of revascularization (CABG 93%, HCR 91%, p = 0.27). Hybrid coronary revascularization was superior in freedom from angina (CABG 70%, HCR 91%, p < 0.001).

Conclusions

For selected patients, HCR is associated with a faster postoperative recovery as well as similar short-term and long-term outcomes when compared with standard on-pump CABG.

Section snippets

Study Population

Our sample consisted of all double on-pump CABG (n = 682) and HCR (n = 147; robotic-assisted minimally invasive bypass graft of the LITA to the LAD and PCI to one of non-LAD vessels) performed in our institution between March 2004 and November 2015. In the HCR group, all patients had a preoperative computed tomography scan of the thorax and pulmonary function test. Selection criteria included patients with double-vessel disease in whom the LAD lesion was not suitable for PCI but was suitable

Results

A total of 546 patients underwent on-pump double CABG, and 144 patients underwent HCR. Mean (± SD) age was 65 ± 10 years in the CABG group and 62 ± 11 years in the HCR group. The majority of patients were male in both groups. The demographics, cardiovascular risk factors, and comorbidities of the population are listed in Table 1. All patients underwent complete revascularization. In the CABG group, the non-LAD revascularization target was the circumflex artery in 233 cases (43%) and right

Comment

In the current study, we present the first analysis of a comparison of two-vessel disease (involving the LAD as one of the non-LAD vessels) treated with two different approaches, HCR (combining robotic-assisted minimally invasive CABG of the LITA to the LAD with PCI of the non-LAD vessels) and conventional on-pump CABG (including a LITA to LAD graft and another graft to one of the non-LAD vessels). Compared with conventional on-pump CABG, HCR performed at least equally as well, with some

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