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International Society For Minimally Invasive Cardiothoracic Surgery

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Hybrid Revascularization Is Not Associated With Increased Macce And Bleeding Complications Compared To Isolated Midcab
Luna Snelders1, Jef Van den Eynde1, Herbert De Praetere1, Mark Coosemans2, Nick Hiltrop3, Johan Bennett1, Steven Jacobs1, Wouter Oosterlinck1.
1KU Leuven, Leuven, Belgium, 2AZ Turnhout, Turnhout, Belgium, 3AZ Groeninge, Kortrijk, Belgium.

BACKGROUND: The hybrid procedure is a promising strategy for myocardial revascularization where PCI and MIDCAB are combined. It is currently unclear whether perioperative PCI is associated with increased complication rates compared to surgery only. The aim of this study was to evaluate outcomes after hybrid revascularization. METHODS: Data from 249 patients who underwent MIDCAB surgery at the University Hospitalis of Leuven between July 2015 and June 2019 were reviewed. One group (n = 70, median age 67 (58,75 - 72,00)) underwent the hybrid revascularisation, the other (n = 179, median age 68 (59 - 74)) underwent isolated MIDCAB surgery (non-hybrid). Antiaggregation medication before surgery, hospital stay, hemoglobin change, peak troponin, total drainage, complications, MACCE-free survival, and graft failure were compared between the two groups. Data are presented as mean SD, median (IQR), or n (%). RESULTS: Demographics are given in Table 1. Significantly more patients were on DAPT therapy in the hybrid group compared to non-hybrid (54,3% vs 15,1%, p<0.001).There was no significant difference in hospital stay (9,60 24,50 vs 7,31 4,40 days, p=0.857), hemoglobin change (- 1,700 1,171 vs -1,578 1,321 g/dl, p=0.392), peak troponin (0,273 1,015 vs 0,177 0,345 μg/L p=0.837), total drainage (669,23 882,739 vs 490,21 384,567 ml, p=0.963), or graft failure (2,9% vs 0,6%, p=0.135) between the two groups. MACCE-free survival after 1 year was comparable between groups (Figure 1). Similarly, rates of minor complications did not differ. CONCLUSIONS: Although both groups showed different anti-aggregation strategy, outcomes and complication rates in hybrid strategy were not inferior to non-hybrid isolated MIDCAB. Although the use of DAPT therapy associated with PCI procedures is an important issue in classical open surgery, the feared dangers and peroperative bleeding risk seem negligible. The hybrid procedure might therefore be considered as a valuable option in patients who would benefit from arterial grafts but who are at high risk for conventional surgery.

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