Mid-term Results Of Hybrid Coronary Revascularization
Yoshitsugu Nakamura, Daiki Yoshiyama, Miho Kuroda, Yuto Yasumoto.
Chibanishi general hospital, Chiba, Japan.
BACKGROUND: Hybrid coronary revascularization (HCR) is synergistic minimally invasive direct coronary artery bypass (MIDCAB) of the left anterior descending artery (LAD) and percutaneous coronary intervention (PCI) of non-left anterior descending vessels to treat multivessel coronary artery disease.
METHODS: We conducted a retrospective (intention-to-treat) analysis of HCR performed at our institution from May 2014 to July 2022. Candidates of HCR were selected by coronary heart team. Our strategy was two stage approach (MIDCAB followed by PCI). MIDCAB was performed by robotic assisted left internal thoracic artery harvesting (LITA) followed by direct vision LITA-LAD anastomosis through 4-5 cm non-rib spreading thoracotomy.
RESULTS: 84 consecutive patients which was 6.8% of 1235 CABG patients during the same period were involved in this study (71.7±9.2 years; 72 males (86%)). Mean SYNTAX score was 29±8. No patient required intraoperative conversion to sternotomy. Mean LITA harvesting time and were 51±13 and 175±32 minutes, respectively. There was no hospital mortality nor stroke after MIDCAB. 82 patients (97.5%) underwent coronary CT scan or coronary angiogram. LITA-LAD bypass patency was 100% (82/82). Mean interval from MIDCAB to PCI was 42 (9-148) days. 14 patients did not receive PCI because of improvement of myocardial ischemia after MIDCAB. PCI was performed for 1 lesion in 34 patients (40.5%), 2 lesions in 25 patients (29.8%), and 3 lesions in 10 patients (12.0%). Freedom from all-cause mortality was 74.3% (95%C: 53.3-86.9%) at 5-year follow-up. Freedom from MACCE (death, myocardial infarction, recurrence of symptom, stroke, target vessel revascularization) was 87.4% 61.4% (CI: 44.3-74.7%) at 5-year follow-up.
CONCLUSIONS: HCR is an effective coronary artery revascularization strategy in selected patients with multivessel coronary artery disease.
Back to 2023 Display ePosters