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Minimally Invasive Hybrid Revascularization (MIHR) in patients with Multi-vessel Coronary Disease (MVD): Mid-term Results.
Alberto Repossini1, Maurizio Tespili2, Antonio Saino2, Igor Kotelnikov1, Lorenzo Di Bacco1, Claudio Muneretto1.
1university of Brescia Medical School, Brescia, Italy, 2Azienda Ospedaliera Bolognini, Seriate, Italy.

OBJECTIVE: Hybrid Coronary Revascularization, meaning Left Mammary Artery on Left Anterior Descending (MIDCAB) combined with non-LAD PCI stenting, is considered as a viable alternative to conventional CABG through sternotomy or to multi-vessel PCI, to perform a functionally complete revascularization. We report our results and mid-term outcomes of this therapeutic strategy.
METHODS: Since January 2009 up to October 2012, 70 consecutive patients underwent hybrid revascularization after Heart Team evaluation. Demographic, pre-operative, intra-operative data and post-operative outcomes were obtained. Coronary risk was assessed by SYNTAX score, and patients were partitioned in tertiles according to the score categories (≤22 low risk, >22 and ≤33 intermediate risk, >33 high risk). Pre-operative risk assessment was upgraded to EuroSCORE II for all patients. Long-term outcomes, major adverse cardiac and cerebrovascular events (MACCE) rate and repeated target vessels revascularization (TVR) rate were evaluated by Kaplan-Meier curve and log-rank test.
RESULTS: Mean age was 66.3 ± 12.0 years and 83.8% of patients were males. Mean SYNTAX score was 28,22 ± 7 (mean SYNTAX score in patients with Left main involved 33,5 ± 4,5). Mean EuroSCORE II was 4,05 ± 1,83. PCI was performed in all patients (n=70), in 52 pts (75,2%) before MIDCAB and in 24,8% of cases after surgery (interval 2,2 ± 1,3 months). In 12 patients (18,6%). No intra-operative or in-hospital deaths were reported. At follow-up one cardiac death for acute inferior myocardial infarction occurred. At 25 ± 13 months follow-up the overall population freedom from MACCEs rate was 82,6% (CI: 79,5% to 85,7%) and the freedom from TVRs rate was 86,1% (CI: 82,9% to 89,3%). Despite the rate of MACCE and TVR was higher in patients with intermediate and high coronary risk than in patients with SYNTAX score ≤ 22, such difference was not statistically significant (p > 0,05).

CONCLUSIONS: Hybrid Coronary Revascularization is a viable option to perform a minimally invasive functionally complete revascularization not only in high risk patient that can’t undergo conventional revascularization. However this strategy has better results when performed on patients with a SYNTAX score ≤ 22.

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