Clinical and angiographic results after hybrid coronary revascularization

Michael E. Halkos*, Patrick F. Walker, Thomas A. Vassiliades, John S. Douglas, Chandan Devireddy, Robert A. Guyton, Aloke V. Finn, S. Tanveer Rab, John D. Puskas, Henry A. Liberman

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

47 Scopus citations

Abstract

Background With hybrid coronary revascularization (HCR), minimally invasive left internal mammary artery (LIMA) to left anterior descending coronary artery (LAD) grafting is combined with percutaneous coronary intervention (PCI) of non-LAD vessels. The purpose of this study was to examine the short-term clinical and angiographic results in one of the largest HCR series to date. Methods From 2003 to 2012, 300 consecutive patients (aged 64 ± 12 years, female 31.7%, predicted risk of mortality 1.6% ± 2.1%) underwent HCR on an intent-to-treat basis at a single institution. After robotic or thoracoscopic LIMA harvest, off-pump LIMA to LAD grafting was performed through a 3- to 4-cm sternal-sparing, non-rib-spreading thoracotomy. PCI was utilized to treat non-LAD lesions either before, after, or concomitant with the surgical procedure. Results Of the 300 patients undergoing HCR on an intent-to-treat basis, HCR was performed with surgery first in 192 patients (64.0%), PCI first in 56 (18.7%), and as a concomitant procedure in 21 (7.0%). Of the 31 patients (10.1%) who did not undergo HCR, 24 patients (8.0%) did not have PCI and thus were incompletely revascularized. For all patients, 30-day mortality, stroke, and nonfatal myocardial infarction occurred in 4 (1.3%), 3 (1.0%), and 4 (1.3%), respectively. Angiographic LIMA evaluation was performed in 248 patients and revealed a FitzGibbon A LIMA patency rate of 97.6% (242 of 248 patients). Repeat revascularization was required in 13 of 300 patients (4.3%). Conclusions Hybrid coronary revascularization represents an alternative approach for patients with multivessel coronary disease with excellent short-term outcomes. It provides a minimally invasive alternative to traditional coronary artery bypass graft surgery and may prove more durable than multivessel PCI.

Original languageEnglish
Pages (from-to)484-490
Number of pages7
JournalAnnals of Thoracic Surgery
Volume97
Issue number2
DOIs
StatePublished - Feb 2014
Externally publishedYes

Keywords

  • CABG
  • DES
  • HCR
  • IMA
  • LAD
  • LIMA
  • OR
  • PCI
  • STS
  • The Society of Thoracic Surgeons
  • coronary artery bypass graft surgery
  • drug-eluting stent
  • hybrid coronary revascularization
  • internal mammary artery
  • left anterior descending coronary artery
  • left internal mammary artery
  • operating room
  • percutaneous coronary intervention

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