A Retrospective Analysis Of 20 Years Single Institution Data Of Hybrid Coronary Artery Revascularization
Maria Cannoletta, Richard Trimlett, Rashmi Yadav, Anthony De Souza.
Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
BACKGROUND:Endoscopic atraumatic coronary artery bypass surgery (EndoACAB) is a relative new procedure performed in specialist centers. In our institution, this technique is often combined with percutaneous coronary intervention as part of a "hybrid" approach to achieve complete revascularization for multivessel coronary artery disease. Here, we report our results of hybrid coronary revascularization over a 20 years period.METHODS:Retrospective review of single center cardiac surgery database over a period of 20 years and 11 months. Patient characteristics, post-operative complications and in hospital mortality are reported.RESULTS:Between January 2000 to November 2021, a total of 932 patients underwent Endoacab in our institution, in 339 of the cases (36.4%) this was combined with percutaneous coronary intervention (PCI) to non-LAD lesions to achieve complete revascularization. Within the hybrid group, 17.9% of the patients (n=61) underwent a "reverse hybrid" procedure, with PCI performed acutely to the culprit lesion followed by EndoACAB with a LIMA to LAD at a later date. In 215 patients (63.4%) 1 vessel was treated with PCI, in 113 patients 2 vessels were treated (33.3%) and in 11 patients more vessels were treated (3.2%). In our series, there were 1.5% conversions (n=5/339) to sternotomy, 1 procedure was abandoned and PCI performed instead. Hospital mortality was 1.18% (n=4/339),mostly in high risk patients. The most common complication was atrial fibrillation experienced by 10.6% of the patients (n=36/339). 4.4% suffered acute kidney injury (n=15/339), 1.5% of the patients had significant wound infections (n= 5), all of this in female with high BMI and diabetic patients. In 2.6% (n=9) of the cases Lima to LAD anastomosis required PCI for occlusion or stenosis. We had one case of emergency sternotomy during PCI as second part of complete revascularization.CONCLUSIONS:We demonstrated that hybrid coronary revascularization approach combining EndoACAB to LAD and PCI to non-LAD vessels is a feasible procedure with excellent outcome.
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