ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
ISMICS 17 Annual Scientific Meeting, 7-10 June 2017, Rome Cavalieri, Rome, Italy
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Hybrid Coronary Revascularization Versus Standard Coronary Artery Bypass Grafting: A Comparative Analysis With Long-term Follow-up
Vincenzo Giambruno, Feras Khaliel, Philip Jones, Michael Chu, Patrick Teefy, Kumar Sridhar, Daniel Bainbridge, Christopher Harle, Bob Kiaii.
London Health Sciences Centre, London Ontario, ON, Canada.

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.


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