Back to Annual Meeting Posters

Background:
Hybrid coronary revascularization (HCR) is a coronary revascularization strategy that combines the advantages of minimally-invasive surgical and percutaneous coronary intervention to treat a given set of cardiac lesions. However, the optimal sequence by which revascularization should be accomplished has not been determined. Our aim therefore was to compare clinical outcomes based on revascularization sequence in a series of patients who were planned for HCR via robotically-assisted totally endoscopic coronary artery bypass (TECAB) and standard PCI.
Methods: 238 patients planned for HCR between 2001 and 2011 were reviewed on an intention-to-treat basis in three groups: patients undergoing PCI prior to TECAB versus PCI post-TECAB versus during a simultaneous procedure. Outcomes evaluated included incidence of surgical revision for bleeding, intra-aortic balloon counter-pulsation device (IABP) placement, atrial fibrillation, cerebrovascular accident (CVA), need for dialysis, ventilation time, intensive care unit (ICU) length of stay (LOS), hospital LOS, 1-year freedom from major adverse cardiovascular and cerebrovascular events (MACCE) and 1-year survival. Demographic features were reviewed to determine baseline differences between each group.
Results:
Of the 238 patients, 175 (74%) underwent TECAB prior to PCI, 38 patients (16%) underwent PCI prior to TECAB and 25 (11%) underwent a simultaneous revascularization procedure. At baseline, patients undergoing TECAB prior to PCI were significantly older but were matched for baseline demographic features of EuroSCORE, body mass index (BMI), ejection fraction (EF) and gender. No significant differences were noted in the incidence of surgical revision for bleeding, IABP placement, atrial fibrillation, CVA, need for dialysis, 1-year freedom from MACCE and 1-year survival between the three groups. There was a significant difference in ICU LOS with a trend towards shorter ICU stays in the simultaneous revascularization group (p=0.031) and a significant difference in hospital LOS with a trend towards shorter hospital stays in PCI prior to TECAB group (p=0.021).
Conclusions:
Surgical revascularization sequence did not dramatically impact evaluated clinical outcomes. Patients undergoing PCI first and simultaneous interventions had shorter hospital LOS and ICU lengths of stay. These differences may be explained by a different demographic risk profile in the TECAB prior to PCI group.