Ralf E Harskamp1, J Matthew Brennan2, Ying Xian2, Michael E Halkos2, John D Puskas2, Vinod H Thourani2, James S Gammie2, Bradley S Taylor2, Robbert J de Winter2, Sunghee Kim2, Sean O'Brien2, Eric D Peterson2, Jeffrey G Gaca2. 1. From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.). r.e.harskamp@gmail.com. 2. From the Duke Clinical Research Institute and Duke University Medical Center, Durham NC (R.E.H., J.M.B., Y.X., S.K., S.O'B., E.D.P., J.G.G.); Academic Medical Center of the University of Amsterdam, Amsterdam, Netherlands (R.E.H., R.J.d.W.); Cardiothoracic Surgery Clinical Research Unit, Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA (M.E.H., V.H.T); Department of Cardiothoracic Surgery, Mount Sinai Beth Israel, New York, NY (J.D.P.); and Heart Center of the University of Maryland Medical Center, Baltimore, MD (J.S.G., B.S.T.).
Abstract
BACKGROUND: Hybrid coronary revascularization (HCR) involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional coronary artery bypass grafting (CABG). METHODS AND RESULTS: Patients were included who underwent HCR (staged/concurrent) or isolated CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2011 to March 2013). HCR represented 0.48% (n=950; staged=809, concurrent=141) of the total CABG volume (n=198,622) during the study period, and was performed in one-third of participating centers (n=361). Patients who underwent HCR had higher cardiovascular risk profiles in comparison with patients undergoing CABG. In comparison with CABG, median sternotomy (98.5% for CABG, 61.1% for staged HCR, and 52.5% for concurrent HCR), direct vision harvesting (98.9%, 66.0%, and 68.1%) and cardiopulmonary bypass (83.4%, 45%, and 36.9%) were less frequently used for staged and concurrent HCR, whereas robotic assistance (0.7%, 33.0%, and 30.5%) was more common. After adjustment, no differences were observed for the composite of in-hospital mortality and major morbidity (odds ratio, 0.93; 95% confidence interval, 0.75-1.16; P=0.53 for staged HCR, and odds ratio, 0.94; 95% confidence interval, 0.56-1.56; P=0.80 for concurrent HCR in comparison with CABG). There was no statistically significant association between operative mortality and either treatment group (odds ratio, 0.74; 95% confidence interval, 0.42-1.30; P=0.29 for staged HCR, and odds ratio, 2.26; 95% confidence interval, 0.99-5.17; P=0.053 for concurrent HCR in comparison with CABG). CONCLUSION: HCR, either as a staged or concurrent procedure, is performed in one-third of US hospitals and is reserved for a highly selected patient population. Although HCR may appear to be an equally safe alternative for CABG surgery, further randomized study is warranted.
BACKGROUND: Hybrid coronary revascularization (HCR) involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional coronary artery bypass grafting (CABG). METHODS AND RESULTS:Patients were included who underwent HCR (staged/concurrent) or isolated CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2011 to March 2013). HCR represented 0.48% (n=950; staged=809, concurrent=141) of the total CABG volume (n=198,622) during the study period, and was performed in one-third of participating centers (n=361). Patients who underwent HCR had higher cardiovascular risk profiles in comparison with patients undergoing CABG. In comparison with CABG, median sternotomy (98.5% for CABG, 61.1% for staged HCR, and 52.5% for concurrent HCR), direct vision harvesting (98.9%, 66.0%, and 68.1%) and cardiopulmonary bypass (83.4%, 45%, and 36.9%) were less frequently used for staged and concurrent HCR, whereas robotic assistance (0.7%, 33.0%, and 30.5%) was more common. After adjustment, no differences were observed for the composite of in-hospital mortality and major morbidity (odds ratio, 0.93; 95% confidence interval, 0.75-1.16; P=0.53 for staged HCR, and odds ratio, 0.94; 95% confidence interval, 0.56-1.56; P=0.80 for concurrent HCR in comparison with CABG). There was no statistically significant association between operative mortality and either treatment group (odds ratio, 0.74; 95% confidence interval, 0.42-1.30; P=0.29 for staged HCR, and odds ratio, 2.26; 95% confidence interval, 0.99-5.17; P=0.053 for concurrent HCR in comparison with CABG). CONCLUSION: HCR, either as a staged or concurrent procedure, is performed in one-third of US hospitals and is reserved for a highly selected patient population. Although HCR may appear to be an equally safe alternative for CABG surgery, further randomized study is warranted.
Authors: Angela Lowenstern; Jingjing Wu; Steven M Bradley; Alexander C Fanaroff; James E Tcheng; Tracy Y Wang Journal: Am Heart J Date: 2019-06-28 Impact factor: 4.749
Authors: John D Puskas; Michael E Halkos; Joseph J DeRose; Emilia Bagiella; Marissa A Miller; Jessica Overbey; Johannes Bonatti; V S Srinivas; Mark Vesely; Francis Sutter; Janine Lynch; Katherine Kirkwood; Timothy A Shapiro; Konstantinos D Boudoulas; Juan Crestanello; Thomas Gehrig; Peter Smith; Michael Ragosta; Steven J Hoff; David Zhao; Annetine C Gelijns; Wilson Y Szeto; Giora Weisz; Michael Argenziano; Thomas Vassiliades; Henry Liberman; William Matthai; Deborah D Ascheim Journal: J Am Coll Cardiol Date: 2016-07-26 Impact factor: 24.094