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International Society For Minimally Invasive Cardiothoracic Surgery

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Angiographic Follow-up In Hybrid Vs Standard Coronary Artery Bypass Grafting. Insights From Polmides (hybrid) Trial
Michal Zembala1, Mariusz Gasior1, Tomasz Hrapkowicz1, Michal Hawranek1, Marian Zembala2, Mateusz Tajstra1
1Silesian Centre for Heart Diseases, Zabrze, Poland, 2Marian Zembala, Zabrze, Poland

Objective. Hybrid coronary artery revascularization (HCR) is a combination of minimally invasive left internal mammary artery bypass grafting to the left anterior descending artery (LAD) and percutaneous coronary interventions (PCI) with drug eluting stents (DES) implantation to other coronary arteries. One of the goal of the trial was 12-month follow-up angiographic measurements of the patency of grafts and restenosis in revascularized segments. To overcome the limitations of classic head-to-head angiographic comparisons of the 2 different revascularization methods, easily calculated, comparable, and consistent tool to assess the angiographic effectiveness of HCR, hybrid patency score (HPS) was created. Methods. Two hundred consecutive patients with angiographically confirmed multivessel CAD involving LAD and a critical (>70%) lesion in at least one major epicardial vessel (except LAD) amenable to both PCI and CABG referred for conventional surgical revascularization, were randomized in a 1:1 fashion for HCR or standard CABG. All included patients were planned for angiographic follow-up after 12-months. Angiographic comparison of the 2 different revascularization methods: hybrid vs standard CABG and its impact on clinical outcomes - major adverse cardiac or cerebrovascular events (MACCE) such as all-cause death, myocardial infarction, stroke, coronary reintervention within the 5-year, were performed. The HPS was used to compare the long-term effect of hybrid revascularization with long-term patency of the grafts after standard CABG defined as grafted or stented arteries free of stenosis and/or occlusions with the total number of grafted and stented arteries ratio.Results. Angiographic follow-up was performed in 85% and 81% of patients in HCR and CABG groups, respectively (p=0.41). The patency of arterial grafts to the LAD was substantial at 94% and 93% (HCR vs. CABG). Although 1 LIMA conduit was significantly narrowedin the HCR group, 5 grafts were found narrowed in the CABG group; 79% of the remaining conduits were free of occlusion and obstruction. In the HCR group, 5.1% stent occlusion rate and 7.5% significant in-stent restenosis was discovered. Although, the HYBRID patency was significantly higher in the HCR group (90% vs. 81%, p=0.01), it’s correlation with 5-year cumulative incidence of MACCE was not recorded (Table 1). Conclusion. The hybrid patency score comparing the long-term effect of hybrid revascularization with long-term patency of the grafts after standard CABG was higher in hybrid group. However, this was not related with long-term clinical outcomes.LEGEND:Table 1. The 12 month follow-up angiographic measurements as patency of grafts and restenosis in revascularized segments and 5-year clinical outcomes.
Table 1. The 12 month follow-up angiographic measurements as patency of grafts and restenosis in rev
VariableHCRCABGP
Angiographic follow-up, %85810.41
LAD arterial graft patency, %94930.74
LAD arterial graft stenosis ≥70%, %150.36
Other grafts patency , %-79NA
In-stent occlusions, %5.1-NA
In-stent restenosis ≥50%, %7.5-NA
HYBRID patency score, %90810.01
The 5-year clinical outcome
Any major adverse cardiac or cerebrovascular events, %45.253.40.39


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