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Off-Pump Hybrid Coronary Revascularization technique: single-centre ten-year results
Marie AYMAMI1, Erwan Flécher1, Olivier Fouquet2, Thierry Langanay1, Jean-Philippe Verhoye1, Hervé Lebreton3, Alain Leguerrier1, Hervé Corbineau1.
1Chirurgie cardiothoracique, Rennes, France, 2Chirurgie cardiothoracique, Angers, France, 3Cardiologie Interventionnelle, Rennes, France.

OBJECTIVE: To assess the results of hybrid coronary revascularization: single-centre ten year experience.
METHODS: Between January 2000 and September 2010, 106 consecutive patients underwent combined coronary revascularization, either the same day (n=20), or within 90 days. We defined 3 groups: combined revascularization the same day than surgery (n=20)-group A-, percutaneous revascularization in acute coronary syndrome before subsequent surgery (n=39) -group B-; and percutaneous revascularization for stable coronary artery disease performed in the same procedure than the diagnostic coronary angiography and subsequent surgery (n=47) -group C-. The day before surgery, control coronary angiography was realized for patients in group B and C. It was not performed in absence of indication of revascularisation of the dilated vessel (myocardial infarction or poor distal run-off). Surgery was performed with the off pump technique in all cases. Mean follow-up was 6.1±2.7 years in 96.2% of patients.
RESULTS: 107 angioplasties were realized (drug-eluting stents:21, bare metal stents:114, ballon angioplasties: 4). Control angiographies were realized for 42 patients. In-stent restenosis were noticed in 7 patients in which 3 required surgical revascularization. Mean number of surgical revascularized coronary arteries was 1.9±0.6, among them 1.8±0.7 with arterial grafts. 93 patients (87.7%) underwent exclusive arterial revascularization. There was 1 reexploration for bleeding (group A) and no in-hospital death. 11 patients died in the follow-up (4, 2, 5 in group A, B and C respectively). Repeat chest pain occurred in 11 patients (3, 3, 5 in group A, B and C respectively), acute coronary syndrome in 1 patient (group B), and myocardial infarction in 2 patients. Repeat PCI was necessary for 6 patients, and repeat surgery for 1 patient (group B). Freedom from ischaemic events (all-causes deaths, angina, acute coronary syndrome, myocardial infarction) was 85.3±3.8% at 5 years and 71.6±6.4% at 10 years (no difference between groups). Freedom from major adverse cardiac or cerebrovascular event (MACCE) was 87.3±3.6% at 5 years and 78.4±5.0% at 10 years (no difference between groups).
CONCLUSIONS: Hybrid coronary revascularization enables use of increased rate of arterial grafts, with very good long-term outcome. Currently, these excellent results lead us to perfom these procedures in a hybrid theatre.


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