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Hybrid Coronary Revascularization Versus Standard Coronary Artery Bypass Grafting: A Comparative Analysis With Long-term Follow-up
Objective: Hybrid Coronary Revascularization (HCR) is a promising coronary revascularization strategy with potential advantages over conventional coronary artery bypass grafting (CABG). We provide a comparative analysis to conventional off- and on-pump CABG with long-term follow-up.
Methods: We considered all HCR cases (n=147 Robotic-assisted minimally invasive direct coronary artery bypass graft of the LITA to the LAD and PCI to a non-LAD vessels), all double off-pump CABG (n=216), and all double on-pump CABG (n=682) performed in our Institution between March 2004 and November 2015. We performed an adjusted analysis using inverse-probability weighting based on the propensity score of receiving either off-pump CABG or HCR and on-pump CABG or HCR.
Results: In the three groups, there was no significant difference in term of rate of re-exploration for bleeding, post-operative atrial fibrillation, perioperative myocardial infarction, stroke, ICU length of stay, in-hospital mortality. In the HCR group there was a lower rate of respiratory failure when compared to the off-pump CABG group (off-pump CABG 4%, HCR 0.7%, P=0.017), and a lower rate of blood transfusion when compared to the on-pump CABG group (on-pump CABG 25%, HCR 14%, P=0.002). The hospital length of stay was shorter in the hybrid group compared to the off- (off-pump CABG 8.1±5.8 day, HCR 4.5±2.1 day, P<0.001) and on-pump (on-pump CABG 6.7±4.7 day, HCR 4.5±2.1 day, P<0.001) CABG groups. After the median follow-up period of 81 (48-113) months (off-pump CABG group), 96 (53-115) months (HCR group), and 70 (37-106) months (on-pump CABG group), there was no significant difference in survival (off-pump CABG 85%, HCR 96%, P=0.054; on-pump CABG 92%, HCR 97%, P=0.13) and freedom from any form of revascularization (off-pump CABG 92%, HCR 91%, P=0.80; on-pump CABG 93%, HCR 91%, P=0.27). HCR was superior in freedom from angina if compared to both off-pump (off-pump CABG 73%, HCR 90%, P<0.001) and on-pump groups (on-pump CABG 70%, HCR 91%, P<0.001).
Conclusions: In selected patients, HCR seems to provide a faster post-operative recovery, similar and excellent short- and long-term outcomes when compared with both on- and off-pump CABG.