Standardizing definitions for hybrid coronary revascularization (original) (raw)
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Journal of the American College of Cardiology, 2013
Beijing, China Objectives This study sought to compare midterm clinical outcomes of 1-stop hybrid coronary revascularization (HCR) with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for the treatment of multivessel coronary artery disease. Background One-stop HCR has emerged to be a feasible and attractive alternative to CABG and PCI in selected patients with multivessel coronary artery disease. Methods From June 2007 to December 2010, 141 consecutive patients underwent 1-stop HCR at Fuwai Hospital. Using propensity score methodology, these patients were matched with 2 separate groups of 141 patients who underwent isolated CABG or PCI during the same period. All patients were stratified by the EuroSCORE (European System for Cardiac Operative Risk Evaluation Score) and the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score. Cutoffs for EuroSCORE (low, 2; medium, >2 and <6; high, !6) and SYNTAX score (low, 24; medium, >24 and <30; high, !30) were identified by tertiles. Three groups' cumulative major adverse cardiac or cerebrovascular events (MACCE) rates in each risk tertile were compared. Results One-stop HCR incurred MACCE rate lower than that with PCI (p < 0.001), but similar to that with CABG (p ¼ 0.140). After stratification by EuroSCORE or SYNTAX score, the cumulative MACCE rates were similar among the 3 groups in low and medium tertiles. But in the high EuroSCORE tertile, patients who underwent 1-stop HCR had a lower MACCE rate than did the groups that underwent CABG (p ¼ 0.030) and PCI (p ¼ 0.006). Meanwhile, patients with a high SYNTAX score who underwent 1-stop HCR had a MACCE rate lower than did those who underwent PCI (p ¼ 0.002), but similar to that of those who underwent CABG (p ¼ 0.362). Conclusions One-stop HCR provides favorable midterm outcomes for selected patients with multivessel coronary artery disease in each risk tertile. For patients with high EuroSCORE or SYNTAX score, it might provide a promising alternative to CABG and PCI.
Journal of the American Heart Association, 2019
Background-Hybrid coronary revascularization (HCR) involves the integration of coronary artery bypass grafting (CABG) and percutaneous coronary intervention to treat multivessel coronary artery disease. Our objective was to perform a comparative analysis with long-term follow-up between HCR and conventional off-pump CABG. Methods and Results-We compared all double off-pump CABG (n=216) and HCR (n=147; robotic-assisted minimally invasive direct CABG of the left internal thoracic artery to the left anterior descending artery and percutaneous coronary intervention to one of the non-left anterior descending vessels) performed at a single institution between March 2004 and November 2015. To adjust for the selection bias of receiving either off-pump CABG or HCR, we performed a propensity score analysis using inverse-probability weighting. Both groups had similar results in terms of re-exploration for bleeding, perioperative myocardial infarction, stroke, blood transfusion, in-hospital mortality, and intensive care unit length of stay. HCR was associated with a higher in-hospital reintervention rate (CABG 0% versus HCR 3.4%; P=0.03), lower prolonged mechanical ventilation (>24 hours) rate (4% versus 0.7%; P=0.02), and shorter hospital length of stay (8.1AE5.8 versus 4.5AE2.1 days; P<0.001). After a median follow-up of 81 (48-113) months for the off-pump CABG and 96 (53-115) months for HCR, the HCR group of patients had a trend toward improved survival (85% versus 96%; P=0.054). Freedom from any form of revascularization was similar between the 2 groups (92% versus 91%; P=0.80). Freedom from angina was better in the HCR group (73% versus 90%; P<0.001). Conclusions-HCR seems to provide, in selected patients, a shorter postoperative recovery, with similar excellent short-and longterm outcomes when compared with standard off-pump CABG.
IJC Heart & Vasculature, 2021
Aims Hybrid revascularization (HCR) has been recently proposed as an alternative strategy in multivessel coronary disease, particularly in patients with high SYNTAX scores and risk scores. The objective of this study is to evaluate the outcomes of HCR versus percutaneous coronary intervention (PCI) drug-eluting stenting in left main treatment. Methods A series of 198 consecutive patients with left main stenosis have been treated. HCR, was performed in 77 patients (G1) whereas 121 patients (G2) received PCI on left main. An adjusted analysis using inverse probability weighting (IPW) was performed. Primary outcomes include: 30-day mortality, postoperative acute myocardial infarction, 18 months' MACCEs: cardiac death, stroke, acute myocardial infarction (AMI), repeated target vessel revascularization (TVR). Results SYNTAX score was 29.5 W 6.9 in G1 and 29.1 W 6.5 in G2 (P U 0.529). In G2, three patients (2.7%) died because of cardiogenic shock; no deaths occurred in G1 (P U 0.603). No major complications were reported in G1 and there was no mortality at 18 months' follow-up in both groups. Survival freedom from MACCEs at 18 months' follow-up was significantly higher in G1 (G1: 93.3 W 4.6% versus G2: 72.3 W 6.3; P U 0.001) mostly because of the higher freedom from TVR (G1: 93.3 W 4.6% versus G2: 75.5 W 5.6; P U 0.002). At Cox regression analysis, PCI was an independent predictor of MACCEs and TVR (hazard ratio 3.9, CI 1.36-9.6; P U 0.027). Conclusion PCI in patients with left main and multivessel disease is a viable strategy, with a good outcome. HCR, demonstrated a lower incidence of cardiac adverse events such as AMI and TVR. Future comparative studies will be helpful to identify the optimal patient population for HCR.
2013
The "hybrid" approach to multivessel coronary artery disease combines surgical left internal thoracic artery (LITA) to left anterior descending coronary artery (LAD) bypass grafting and percutaneous coronary intervention of the remaining lesions. Ideally, the LITA to LAD bypass graft is performed in a minimally invasive fashion. This review aims to clarify the place of hybrid coronary revascularization (HCR) in the current therapeutic armamentarium against multivessel coronary artery disease. Eighteen studies including 970 patients were included for analysis. The postoperative LITA patency varied between 93.0% and 100.0%. The mean overall survival rate in hybrid treated patients was 98.1%. Hybrid treated patients showed statistically significant shorter hospital length of stay (LOS), intensive care unit (ICU) LOS, and intubation time, less packed red blood cell (PRBC) transfusion requirements, and lower in-hospital major adverse cardiac and cerebrovascular event (MACCE) rates compared with patients treated by on-pump and off-pump coronary artery bypass grafting (CABG). This resulted in a significant reduction in costs for hybrid treated patients in the postoperative period. In studies completed to date, HCR appears to be a promising and cost-effective alternative for CABG in the treatment of multivessel coronary artery disease in a selected patient population.
Hybrid coronary artery revascularization: initial experience of a single centre
European Heart Journal Supplements, 2015
Current guidelines recommend coronary bypass grafting (CABG) as the treatment of choice for patients with triple vessel and left main disease, although the growing use of drug-eluting stents (DES) has significantly reduced the rate of restenosis and extended the use of percutaneous coronary interventions (PCIs). Hybrid coronary revascularization (HCR) integrates the positive features of both PCI and CABG. We present preliminary results of a prospective study designed to verify the selection of candidates for treatment with hybrid approach. Between September 2011 and August 2014, 42 patients [(M ¼ 37 (88.1%); mean age 68.6 + 10.3 years, range 53-90] were selected to receive a complete (all lesions of main vessels treated) coronary revascularization with a hybrid approach at our Institution. Age-creatinine-ejection-fraction score was high (.1.277) in 16 (38%) patients, median 1.2 (0.77; 2.89). All patients underwent off-pump single-vessel revascularization (left internal thoracic artery to the left anterior descending coronary artery) using a left-anterior small thoracotomy and percutaneous coronary angioplasty. Eighteen patients (42.8%) underwent a simultaneous hybrid approach. Drug-eluting stents were used to treat 49 lesions, were also implanted 6 (7.6%) bioabsorbable stents. Procedural success was obtained in 41 (97.6%) patients. No conversion to full sternotomy and no blood transfusions were necessary during surgery. Median ventilation time was 7.7 (3-33) h and median hospital length of stay was 6 days (3-14). All patients were alive at discharge. Our early experience with HCR shows encouraging results. Randomized studies on a larger series with a longer follow-up are required.
Role and Rationale for Hybrid Coronary Artery Revascularization
Coronary Artery Disease - Assessment, Surgery, Prevention, 2015
The optimal revascularization strategy for patients with multi-vessel coronary artery disease remains controversial. The advent of percutaneous coronary intervention (PCI) has challenged the superiority of coronary artery bypass graft (CABG) surgery for multi-vessel disease. In the late 1990s, an integrated approach, now referred to as "hybrid coronary revascularization" (HCR), was pioneered combining CABG and PCI to offer appropriate patients a less invasive option for revascularization while still capitalizing on the superior patency rates of the left internal mammary artery (LIMA) to the left anterior descending (LAD) artery bypass. The operative techniques continue to evolve as well as the timing strategies for intervention and use of antiplatelet therapy. While more research is needed, current data supports hybrid coronary revascularization as a promising technique to optimize outcomes in patients with multi-vessel coronary artery disease.
Hybrid Coronary Revascularization
Journal of the American College of Cardiology, 2015
Hybrid coronary revascularization (HCR) combines arterial coronary artery bypass surgery (most commonly minimally invasive) and percutaneous coronary intervention in the treatment of a particular subset of multivessel coronary artery disease. It was first introduced in the mid-1990s, and aspired to bring together the "best of both worlds": the excellent patency rates and survival benefits associated with the durable left internal mammary artery graft to the left anterior descending artery alongside the good patency rates of drug-eluting stents, which outlive saphenous vein grafts to non-left anterior descending vessels. Although in theory this is a very attractive revascularization strategy, several years later, only one small randomized controlled trial comparing HCR with coronary artery bypass grafting has recently emerged in the medical literature, raising concerns regarding HCR's role and generalizability. In the current review, we discuss HCR's rationale, the current evidence behind it, its limitations and procedural challenges.