Hybrid Coronary Revascularization At 10 Years: A Comparative Analysis To Coronary Artery Bypass Grafting
Ali Hage, Fadi Hage, Philip Jones, Michael W.A. Chu, Christopher Harle, Ivan Iglesias, Patrick Teefy, Bob Kiaii
Western University, London, ON, Canada
BACKGROUND: Hybrid Coronary Revascularization (HCR) is an evolving field that combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) to treat multivessel coronary artery disease. We provide a comparative analysis of HCR to conventional CABG with long-term follow-up.
METHODS: Our sample consisted of all double-vessels CABG (n=901) and HCR (n=147, robotic-assisted minimally-invasive CABG of the left internal thoracic artery to the left anterior descending artery and PCI to one of non-LAD vessels) performed at 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 CABG or HCR. The propensity score was calculated using an a priori logistic regression model based on covariates deemed from clinical experience or from previous literature to likely be predictive of the surgical approach used or the outcomes of interest.
RESULTS: Both groups had similar results in terms of re-exploration for bleeding, in-hospital re-intervention rate, perioperative myocardial infarction, stroke, hemodialysis, blood transfusion, and ICU length of stay (LOS). HCR was associated with a lower prolonged mechanical ventilation (>24 hours) rate (CABG 2.5% (n=19) vs. HCR 0.7% (n=1), P=0.007), shorter hospital LOS (CABG 7.0±5.2 days vs. HCR 4.5±2.1 days, P<0.001), and lower in-hospital mortality (CABG 1.2% (n=9) vs. HCR 0%, P=0.003). After a median (interquartile range) follow-up period of 73 (40-111) months for the CABG group and 96 (53-114) months for the HCR group, there was a numerical, but not statistical, improved survival in favors of HCR (CABG 90% (n=598/668) vs. HCR 96% (n=129/134), P=0.47). HCR was superior in freedom from angina (CABG 71% (n=422/598) vs. HCR 91% (117/129), P=0.039). There was no difference between groups in freedom from any revascularization (CABG 92% (n=551/597) vs. HCR 91% (n=117/129), P=0.054).
CONCLUSIONS: In selected patients, HCR appears to be safe and seems to provide excellent short- and long-term outcomes when compared with standard CABG. It is associated with a faster post-operative recovery, shorter hospital LOS, improved in-hospital survival, and better freedom from angina at long-term follow-up. 
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