Edward L Hannan1, Yifeng Wu1, Kimberly Cozzens1, Thoralf M Sundt2, Leonard Girardi3, Joanna Chikwe4, Andrew Wechsler5, Craig R Smith6, Jeffrey P Gold7, Stephen J Lahey8, Desmond Jordan9. 1. School of Public Health, University at Albany, State University of New York, NY (E.L.H., Y.W., K.C.). 2. Cardiac Surgical Division, Massachusetts General Hospital, Boston (T.M.S.). 3. Department of Cardiothoracic Surgery, Weill Cornell Medical Center, NY (L.G.). 4. Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (J.C.). 5. Department of Cardiothoracic Surgery, Drexel University, Philadelphia, PA (A.W.). 6. Department of Surgery, Columbia-Presbyterian Medical Center, NY (C.R.S.). 7. Chancellor, University of Nebraska Medical Center, Omaha, NE (J.P.G.). 8. Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.). 9. Department of Anesthesiology, Columbia-Presbyterian Medical Center, NY (D.J.).
Abstract
BACKGROUND: Hybrid coronary revascularization (HCR) treats multivessel coronary artery disease by combining a minimally invasive surgical approach to the left anterior descending artery with percutaneous coronary intervention for non-left anterior descending diseased coronary arteries. The objective of this study is to compare HCR and conventional coronary artery bypass graft (CABG) surgery medium-term outcomes. METHODS: Data from multivessel disease patients in New York's cardiac surgery and percutaneous coronary intervention registries in 2010 to 2016 were used to compare mortality and repeat revascularization rates for HCR and conventional CABG after using propensity matching to reduce selection bias. RESULTS: There was a total of 303 HCR (0.80%) patients and 37 556 conventional CABG patients after exclusions. After propensity matching, the respective median follow-up times were 3.72 years and 3.76 years. There was no difference between HCR and conventional CABG in survival at 6 years (80.9% versus 85.8%%, adjusted hazard ratio, 1.44 [0.90-2.31]), but HCR had higher mortality excluding deaths during the first year (adjusted hazard ratio, 1.88 [1.10-3.23]). Conventional CABG patients were more likely to be free from repeat revascularization at 6 years than HCR patients (88.2% versus 76.6%; hazard ratio, 2.22 [1.44-3.42]). CONCLUSIONS: HCR is rarely performed for patients with multivessel coronary artery disease. HCR and conventional CABG had no different 6-year mortality rates, but HCR had higher mortality after 1 year and higher rates of subsequent revascularization that were caused by both the need for repeat revascularization in the left anterior descending artery where minimally invasive CABG was performed, and in the coronary arteries where percutaneous coronary intervention was performed. Graphic Abstract: A graphic abstract is available for this article.
BACKGROUND: Hybrid coronary revascularization (HCR) treats multivessel coronary artery disease by combining a minimally invasive surgical approach to the left anterior descending artery with percutaneous coronary intervention for non-left anterior descending diseased coronary arteries. The objective of this study is to compare HCR and conventional coronary artery bypass graft (CABG) surgery medium-term outcomes. METHODS: Data from multivessel disease patients in New York's cardiac surgery and percutaneous coronary intervention registries in 2010 to 2016 were used to compare mortality and repeat revascularization rates for HCR and conventional CABG after using propensity matching to reduce selection bias. RESULTS: There was a total of 303 HCR (0.80%) patients and 37 556 conventional CABG patients after exclusions. After propensity matching, the respective median follow-up times were 3.72 years and 3.76 years. There was no difference between HCR and conventional CABG in survival at 6 years (80.9% versus 85.8%%, adjusted hazard ratio, 1.44 [0.90-2.31]), but HCR had higher mortality excluding deaths during the first year (adjusted hazard ratio, 1.88 [1.10-3.23]). Conventional CABG patients were more likely to be free from repeat revascularization at 6 years than HCR patients (88.2% versus 76.6%; hazard ratio, 2.22 [1.44-3.42]). CONCLUSIONS: HCR is rarely performed for patients with multivessel coronary artery disease. HCR and conventional CABG had no different 6-year mortality rates, but HCR had higher mortality after 1 year and higher rates of subsequent revascularization that were caused by both the need for repeat revascularization in the left anterior descending artery where minimally invasive CABG was performed, and in the coronary arteries where percutaneous coronary intervention was performed. Graphic Abstract: A graphic abstract is available for this article.
Authors: Dongjie Li; Yulin Guo; Yingdi Gao; Xiangguang An; Yan Liu; Song Gu; Xitao Zhang; Jiuchang Zhong; Jie Gao; Pixiong Su Journal: Front Cardiovasc Med Date: 2021-12-17
Authors: Jef Van den Eynde; Michel Pompeu Sá; Senne De Groote; Andrea Amabile; Serge Sicouri; Basel Ramlawi; Gianluca Torregrossa; Wouter Oosterlinck Journal: Int J Cardiol Heart Vasc Date: 2021-12-01