Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting for the Treatment of Multivessel Coronary Artery Disease

• Published in: The Annals of thoracic surgery Vol. 92; no. 5; pp. 1695 - 1702
• Main Authors: Halkos, Michael E., MD, Vassiliades, Thomas A., MD, MBA, Douglas, John S., MD, Morris, Douglas C., MD, Rab, S. Tanveer, MD, Liberman, Henry A., MD, Samady, Habib, MD, Kilgo, Patrick D., MS, Guyton, Robert A., MD, Puskas, John D., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2011; Elsevier
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Coronary Artery Bypass, Off-Pump; Coronary Disease - surgery; Coronary heart disease; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Revascularization - methods; Pneumology; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; 23; Treatment; Coronary artery bypass; Cardiovascular disease; Anesthesia; Circulatory system; Cardiology; Coronary heart disease; Comparative study; Pump
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2011.05.090

Background Hybrid coronary revascularization (HCR) combines a minimally invasive (3-cm anterolateral thoracotomy), sternal-sparing, off-pump left internal mammary artery–left anterior descending (LIMA-LAD) coronary artery anastomosis with percutaneous coronary intervention (PCI) to non-LAD coronary arteries. We compared outcomes of HCR versus traditional off-pump coronary artery bypass grafting (OPCAB) for the treatment of multivessel coronary artery disease (CAD). Methods Between October 8, 2003 and April 23, 2010, 147 patients with multivessel coronary disease were treated with HCR at a US academic center. These were matched 4:1 to 588 contemporaneous patients treated with multivessel OPCAB by sternotomy using an optimal matching algorithm with 8 preoperative variables: age, gender, ejection fraction, presence of diabetes, myocardial infarction (MI), number of diseased vessels, left main coronary artery disease, and Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score. In-hospital major adverse events (MACCE) and the need for repeated revascularization during follow-up were compared between groups. All-cause mortality was determined using the Social Security Death Index (SSDI). Results Matching produced groups with similar coronary anatomy and statistically similar preoperative risk factors. The incidence of MACCE was similar between groups (3/147 HCR versus 12/588 OPCAB). During a median 3.2 years of follow up, the need for repeated revascularization was higher for HCR than for OPCAB (18/147 [12.2%] versus 22/588 [3.7%]; p < 0.001). The incidence of blood transfusion was higher for the OPCAB group. Estimated 5-year survival was similar between groups (OPCAB, 84.3% versus HCR, 86.8%; p = 0.61). Conclusions Hybrid coronary revascularization is a minimally invasive treatment for multivessel CAD. Although repeated revascularization was greater with HCR, both in-hospital and midterm outcomes were comparable with those of traditional OPCAB. Further investigation into the comparative effectiveness of this alternative strategy is warranted.