In-hospital Outcomes Of Hybrid Coronary Revascularization: Stent Or Surgery First - Is There A Difference In Outcomes?
Sohrab K. Vatsia, Jonathan M. Hemli, Jessica M. Nino, Luigi Pirelli, Derek R. Brinster, S Jacob Scheinerman, Nirav C. Patel.
Lenox Hill Hospital, New York, NY, USA.
BACKGROUND: Hybrid coronary revascularization (HCR), constituting minimally-invasive bypass of the left anterior descending coronary artery (LAD) with an in-situ internal mammary artery (LIMA) graft (MIDCAB), coupled with percutaneous intervention (PCI) to the other coronary distributions, is an established technique for the treatment of multi-vessel coronary artery disease. There is a paucity of evidence in the current literature assessing the efficacy of HCR with respect to the timing of the MIDCAB component relative to the PCI. We evaluated the in-hospital outcomes of patients undergoing HCR, comparing those who had PCI prior to their MIDCAB, with those who underwent MIDCAB before their PCI. METHODS: A retrospective review was undertaken of 203 patients who underwent robotic-assisted MIDCAB as part of a global HCR strategy. Of this cohort, 80 patients (39.4%) had PCI first, followed by MIDCAB (Group 1), and their outcomes were compared with the remaining 123 patients (60.6%) who underwent MIDCAB prior to PCI (Group 2). RESULTS: Thirty-day mortality was zero in both groups. There were no significant difference in mean operative times between the two groups (151.0 ± 56.6 vs. 150.66 ± 42.2 minutes, Group 1 vs. Group 2, respectively), nor were there notable differences in total robotic time (48.6 ± 15.3 vs. 50.0 ±16.7 minutes), or in LIMA mobilization time (32.1 ± 19.3 vs. 26.8 ± 15.8 minutes). Group 1 patients experienced more total in-hospital complications (n = 23, 38.8%) than did those in Group 2 (n = 19, 15.4%) (p = 0.046). The re-exploration rate for bleeding was higher in Group 1 (n = 5, 6.3%) than it was in Group 2 (n = 2, 1.6%). A larger proportion of patients in Group 1 (n = 18, 22.5%) required perioperative transfusion than did patients in Group 2 (n = 6, 4.9%) (p < 0.001). CONCLUSIONS: As part of a HCR strategy, undertaking MIDCAB first, followed by the PCI component, may be associated with lower rates of in-hospital complications, and may necessitate less perioperative transfusion.
Back to 2018 ePosters