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Shimamura J, Miyamoto Y, Hibino M, Fukuhara S, Takayama H, Itagaki S, Takagi H, Kuno T. Long-Term Outcomes After Hybrid Coronary Revascularization Versus Coronary Artery Bypass Grafting: Meta-Analysis of Kaplan-Meier-Derived Data. Am J Cardiol 2024; 212:13-22. [PMID: 38008347 DOI: 10.1016/j.amjcard.2023.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 11/28/2023]
Abstract
Hybrid coronary revascularization (HCR) is an alternative option to conventional coronary artery bypass grafting (CABG), but the long-term outcomes of HCR versus CABG remain unclear. We aimed to analyze the long-term outcomes after HCR and CABG for patients with multivessel coronary artery disease using meta-analysis. A systemic literature search of PubMed and EMBASE was performed from inception to March 2023. Studies reporting Kaplan-Meier curves with follow-up ≥1 year were included. The primary outcome was all-cause mortality, and the secondary outcomes were major adverse cardiac and cerebrovascular events (MACCEs) and repeat revascularization. In total, 13 studies (1 randomized controlled trial and 12 propensity-score matched observational studies) were analyzed. The mean follow-up period was 5.1 ± 3.1 years. HCR was associated with similar overall mortality (hazard ratio [HR] 1.09, 95% confidence interval [CI] 0.87 to 1.36), significantly higher incidence of MACCEs (HR 1.49, 95% CI 1.07 to 2.06), and repeat revascularization (HR 2.01, 95% CI 1.53 to 2.64) compared with CABG. In phase-specific analysis, the mortality rate was similar, and the incidence of repeat revascularization was higher in HCR regardless of phases. The incidence of MACCEs was higher in HCR during the mid-term phase (1 to 5 years), but it was similar during the long-term phase (long-term: ≥5 years). In conclusion, despite the higher incidence of MACCEs and repeat revascularization compared with CABG, HCR offered a similar long-term survival. Even longer-term follow-up and randomized controlled trials with a large population are warranted to investigate the role of HCR for multivessel coronary artery disease.
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Affiliation(s)
- Junichi Shimamura
- Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, University of Tokyo, Tokyo, Japan
| | - Makoto Hibino
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein Medical College, Bronx, New York; Division of Cardiology, Jacobi Medical Center, Albert Einstein Medical College, Bronx, New York.
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Jiang Z, Zhang M, Qin Y, Li Y, Lu X. Usefulness of layer-specific strain for evaluating and predicting recovery of left ventricular myocardial function in patients undergoing hybrid coronary revascularization. Int J Cardiovasc Imaging 2023; 39:491-9. [PMID: 36327011 DOI: 10.1007/s10554-022-02746-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 10/10/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE This study aimed to determine if layer-specific strain (LSS) can be used to evaluate and predict left ventricular (LV) recovery in patients with multi-vessel coronary artery disease (CAD) undergoing hybrid coronary revascularization (HCR) using speckle tracking echocardiography (STE). METHODS A total of 187 consecutive CAD patients who received HCR in our hospital were prospectively enrolled. 30 healthy individuals with matched age and gender were enrolled as a control group. Echocardiography was performed for CAD patients before and 1, 2, and 6 months after HCR. Comprehensive conventional and LSS echocardiography parameters were collected. LV recovery was defined as improvement in LV ejection fraction (LVEF) > 5% at 6-months follow-up compared with baseline. Logistic regression analysis was used to test the correlates of LV recovery. Receiver operating characteristic curve analysis was used to determine the optimal cutoff value of correlates for predicting LV recovery. RESULTS LVEF and LV strain in CAD patients were significantly decreased compared with control subjects. Endocardial global longitudinal strain (Endo-GLS) improved significantly at 1-month follow-up (14.2 ± 1.6% vs. 13.8 ± 1.5%, P < 0.05), and LVGLS and global circumferential strain (GCS) improved significantly at 2-months follow-up. Multivariate regression revealed that Endo-GLS, GLS, and SYNTAX score before HCR were independently correlated to LV recovery. Endo-GLS had an optimal cutoff value of 13.2% for predicting LV recovery with sensitivity of 91% and specificity of 78%. CONCLUSION LV myocardial systolic function in CAD patients was impaired before HCR and significantly improved after HCR. Endo-GLS was independently correlated to and has optimal predictive value for LV recovery.
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Anderson D, Chen S, Southard J, Catrip-Torres JM, Kiaii B. Multidisciplinary approach to coronary artery revascularization: Optimal strategy for high-risk patients. J Card Surg 2022; 37:2900-2902. [PMID: 35701995 DOI: 10.1111/jocs.16685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/27/2022] [Accepted: 06/04/2022] [Indexed: 11/28/2022]
Abstract
High-risk patients that are not candidates for conventional coronary artery bypass grafting surgery can undergo coronary artery revascularization through less invasive procedures. Hybrid approaches have emerged to address coronary artery disease in this subset of patients. This case report highlights the successful application of a multidisciplinary heart team approach for hybrid coronary revascularization in a very high-risk patient with complex coronary anatomy, who would not otherwise be a candidate for conventional modalities of revascularization. The optimal workup, selection criteria based on anatomy, anticoagulation strategies, and timing of intervention of hybrid coronary revascularization are outlined in this case report.
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Affiliation(s)
- Devon Anderson
- Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Sarah Chen
- Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Jeffrey Southard
- Division of Cardiology, University of California Davis Medical Center, Sacramento, California, USA
| | - Jorge Manuel Catrip-Torres
- Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Bob Kiaii
- Division of Cardiothoracic Surgery, University of California Davis Medical Center, Sacramento, California, USA
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Yu L, Zhu K, Du N, Si Y, Liang J, Shen R, Chen B. Comparison of hybrid coronary revascularization versus coronary artery bypass grafting in patients with multivessel coronary artery disease: a meta-analysis. J Cardiothorac Surg 2022; 17:147. [PMID: 35672788 PMCID: PMC9175312 DOI: 10.1186/s13019-022-01903-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 05/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are widely used in the treatment of coronary heart disease, but the best revascularization method for multivessel coronary artery disease (MVD) patients is still controversial. Hybrid coronary revascularization (HCR), together with CABG and PCI, have been proved to be feasible methods, but the long-term effect of HCR is not as clear as CABG.
Method
By October 2020, we retrieved articles from PubMed, Web of science, EMBASE and Cochrane library databases. The main results are based on major adverse cardiovascular and cerebral events (MACCE).
Result
A total of 18 articles (3 randomized controlled trials (RCTs) and 15 observational studies) were included in this meta-analysis. The outcomes of MACCE in the HCR group at perioperative, short-term (30 days to 1 year), medium-term (1 year to 5 years) and long-term (5 years and above) follow-up period were similar to those in the CABG group. The mortality rates of patients in perioperative, short-term and medium-term follow-up were similar to those in the CABG group, but lower than that in the CABG group at long-term follow-up (OR = 0.35, 95% CI 0.18–0.69, p = 0.002). The revascularization rate was higher in the HCR group during the perioperative period (OR = 3.50, 95% CI 2.07–5.94, p < 0.001), short-term (OR = 3.28, 95% CI 1.62–6.64, p < 0.001) and mid-term follow-up (OR = 2.84, 95% CI 1.64–4.92, p < 0.001).
Conclusion
Our results reveal that HCR is a safe and therapeutically effective alternative in treatments for MVD patients. It has not only less short-term adverse effect, but also better long-term effect, especially in death.
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Li Y, Zhang Z, Gao J, Li C, Li K, Su P, Wang L. One-Stop Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting. Int Heart J 2022; 63:441-446. [PMID: 35650145 DOI: 10.1536/ihj.21-705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
One-stop hybrid coronary revascularization (HCR) is a promising revascularization strategy for treating multivessel coronary artery disease (MVCAD). However, its safety and feasibility remain controversial. Therefore, we introduced our experience with midterm follow-up of HCR in patients with MVCAD and compared it with conventional off-pump coronary artery bypass grafting (CABG).Patients with MVCAD undergoing one-stop HCR at Beijing Chaoyang Hospital between March 2018 and December 2020 were retrospectively enrolled. These patients were matched in a 1:2 ratio to patients treated with off-pump CABG at the same period via a propensity score analysis with the nearest neighbor matching algorithm.In the adjusted analysis, no significant difference was found in the rate of perioperative myocardial infarction, stroke, death, prolonged ventilation, reoperation for bleeding, and renal failure between the HCR group and the CABG group. No in-hospital repeated revascularization occurred in either group. HCR was associated with lower blood transfusion rate (HCR 11.0% versus CABG 22.8%; P = 0.006) and shorter postoperative length of stay (> 10 days: 31.5% versus 81.0%; P < 0.001) compared with CABG. After the median 21-month follow-up, no significant difference was found in the major adverse cardiac and cerebrovascular events (MACCE), death, myocardial infarction, repeated revascularization, and stroke rate. Besides, the freedom-from MACCE survival rate was similar between the two groups.One-stop HCR seemed to be a safe and feasible revascularization strategy in patients with MVCAD, with faster recovery and similar outcomes when compared with off-pump CABG.
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Affiliation(s)
- Yanyan Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University
| | - Zhiyong Zhang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University
| | - Jie Gao
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University
| | - Chuang Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University
| | - Kuibao Li
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University
| | - Pixiong Su
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University
| | - Lefeng Wang
- Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University
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Hinojosa-Gonzalez DE, Bueno-Gutierrez LC, Salan-Gomez M, Tellez-Garcia E, Ramirez-Mulhern I, Sepulveda-Gonzalez D, Ramonfaur D, Roblesgil-Medrano A, Flores-Villalba E. Hybrid revascularization vs. coronary bypass for coronary artery disease: a systematic review and meta-analysis. J Cardiovasc Surg (Torino) 2022; 63:353-368. [PMID: 35343660 DOI: 10.23736/s0021-9509.22.12163-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Coronary artery bypass graft is the mainstay of treatment for multivessel coronary artery disease and is superior to percutaneous coronary intervention. Combined approaches such as hybrid coronary revascularization integrate coronary artery bypass grafting with percutaneous coronary intervention during the same procedure or weeks apart. These attempt to improve surgical morbidity and long-term outcomes. EVIDENCE ACQUISITION Per PRISMA criteria, a systematic review of keywords "Hybrid Revascularization," "Hybrid Coronary Revascularization," "Surgical," "Surgery," "Treatment," "CABG," "HCR" and "PCI" was conducted in PubMed, EMBASE and SCOPUS. Studies comparing this technique's performance on either single or two-stage approach against traditional multiple vessel coronary artery bypass grafting were screened and analyzed for our review. EVIDENCE SYNTHESIS Twenty-two studies totaling 6981 participants were ultimately included for analysis. Mean differences in operative time, bleeding, ventilator time and length of stay were significantly lower in the hybrid coronary revascularization group. Odds ratios in transfusions and in-hospital myocardial infarction were also lower in the hybrid coronary revascularization group. Results for in-hospital and all-cause mortality, major adverse cardiac events (MACE), stroke, reintervention, and complete revascularization were not significantly different. CONCLUSIONS Our analysis shows hybrid coronary revascularization is a feasible alternative to traditional coronary artery bypass grafting. Short-and long-term outcomes including mortality, MACE, and postoperative morbidity are similar between both groups, while hybrid approaches are associated with decreased perioperative morbidity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eduardo Flores-Villalba
- School of Medicine and Health Sciences TecSalud ITESM, Monterrey, Mexico -
- School of Engineering and Sciences TecSalud ITESM, Monterrey, Mexico
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Monterrey, Mexico
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Nakamura M, Yaku H, Ako J, Arai H, Asai T, Chikamori T, Daida H, Doi K, Fukui T, Ito T, Kadota K, Kobayashi J, Komiya T, Kozuma K, Nakagawa Y, Nakao K, Niinami H, Ohno T, Ozaki Y, Sata M, Takanashi S, Takemura H, Ueno T, Yasuda S, Yokoyama H, Fujita T, Kasai T, Kohsaka S, Kubo T, Manabe S, Matsumoto N, Miyagawa S, Mizuno T, Motomura N, Numata S, Nakajima H, Oda H, Otake H, Otsuka F, Sasaki KI, Shimada K, Shimokawa T, Shinke T, Suzuki T, Takahashi M, Tanaka N, Tsuneyoshi H, Tojo T, Une D, Wakasa S, Yamaguchi K, Akasaka T, Hirayama A, Kimura K, Kimura T, Matsui Y, Miyazaki S, Okamura Y, Ono M, Shiomi H, Tanemoto K. JCS 2018 Guideline on Revascularization of Stable Coronary Artery Disease. Circ J 2022; 86:477-588. [DOI: 10.1253/circj.cj-20-1282] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Hirokuni Arai
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine
| | | | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Kiyoshi Doi
- General and Cardiothoracic Surgery, Gifu University Graduate School of Medicine
| | - Toshihiro Fukui
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kumamoto University
| | - Toshiaki Ito
- Department of Cardiovascular Surgery, Japanese Red Cross Nagoya Daiichi Hospital
| | | | - Junjiro Kobayashi
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tatsuhiko Komiya
- Department of Cardiovascular Surgery, Kurashiki Central Hospital
| | - Ken Kozuma
- Department of Internal Medicine, Teikyo University Faculty of Medicine
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Hiroshi Niinami
- Department of Cardiovascular Surgery, Tokyo Women’s Medical University
| | - Takayuki Ohno
- Department of Cardiovascular Surgery, Mitsui Memorial Hospital
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | | | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Graduate School of Medical Sciences, Kanazawa University
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Yokoyama
- Department of Cardiovascular Surgery, Fukushima Medical University
| | - Tomoyuki Fujita
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Tokuo Kasai
- Department of Cardiology, Uonuma Institute of Community Medicine, Niigata University Uonuma Kikan Hospital
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Susumu Manabe
- Department of Cardiovascular Surgery, Tsuchiura Kyodo General Hospital
| | | | - Shigeru Miyagawa
- Frontier of Regenerative Medicine, Graduate School of Medicine, Osaka University
| | - Tomohiro Mizuno
- Department of Cardiovascular Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University
| | - Noboru Motomura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Toho University
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine
| | - Hiroyuki Nakajima
- Department of Cardiovascular Surgery, Saitama Medical University International Medical Center
| | - Hirotaka Oda
- Department of Cardiology, Niigata City General Hospital
| | - Hiromasa Otake
- Department of Cardiovascular Medicine, Kobe University Graduate School of Medicine
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ken-ichiro Sasaki
- Division of Cardiovascular Medicine, Kurume University School of Medicine
| | - Kazunori Shimada
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Tomoki Shimokawa
- Department of Cardiovascular Surgery, Sakakibara Heart Institute
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Tomoaki Suzuki
- Department of Cardiovascular Surgery, Shiga University of Medical Science
| | - Masao Takahashi
- Department of Cardiovascular Surgery, Hiratsuka Kyosai Hospital
| | - Nobuhiro Tanaka
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | | | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University Graduate School of Medical Sciences
| | - Dai Une
- Department of Cardiovascular Surgery, Okayama Medical Center
| | - Satoru Wakasa
- Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine
| | - Koji Yamaguchi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Yoshiro Matsui
- Department of Cardiovascular and Thoracic Surgery, Graduate School of Medicine, Hokkaido University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Kindai University
| | | | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Nenna A, Nappi F, Spadaccio C, Greco SM, Pilato M, Stilo F, Montelione N, Catanese V, Lusini M, Spinelli F, Chello M. Hybrid coronary revascularization in multivessel coronary artery disease: a systematic review. Future Cardiol 2022; 18:219-234. [PMID: 35006006 DOI: 10.2217/fca-2020-0244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Hybrid coronary revascularization (HCR) for multivessel coronary artery disease (CAD) integrates coronary artery bypass grafting (CABG) and percutaneous intervention in a planned revascularization strategy. This systematic review summarizes the state of this art of this technique. Methods: Major databases searched until October 2021. Results: The available literature on HCR includes three randomized trials, ten meta-analysis and 27 retrospective studies. The greatest benefits are observed in patients with low-to-intermediate risk and less complex coronary anatomy; highly complex disease and the presence of risk factors favored conventional CABG in terms of adverse events and survival. Conclusion: HCR is an interesting approach for multivessel CAD but should not be considered a 'one-size-fits-all' procedure. Further studies will specify the subset of patients likely to benefit most from this hybrid approach.
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Affiliation(s)
- Antonio Nenna
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Francesco Nappi
- Cardiac surgery, Centre Cardiologique du Nord, Rue des Moulins Gémeaux 32, Saint Denis 93200, Paris, France
| | - Cristiano Spadaccio
- Cardiac surgery, Golden Jubilee National Hospital, Agamemnon St, Clydebank G814DY, Glasgow, United Kingdom
| | - Salvatore Matteo Greco
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy.,Cardiac surgery, ISMETT-IRCCS, Via Ernesto Tricomi 5, Palermo 90127, Italy
| | - Michele Pilato
- Cardiac surgery, ISMETT-IRCCS, Via Ernesto Tricomi 5, Palermo 90127, Italy
| | - Francesco Stilo
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Nunzio Montelione
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Vincenzo Catanese
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Mario Lusini
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Francesco Spinelli
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
| | - Massimo Chello
- Cardiovascular surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome 00128, Italy
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Wang C, Li P, Zhang F, Li J, Kong Q. Is hybrid coronary revascularization really beneficial in the long term? Eur J Cardiothorac Surg 2021; 60:1158-1166. [PMID: 34151954 DOI: 10.1093/ejcts/ezab161] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This analysis aimed to compare both short- and long-term outcomes of hybrid coronary revascularization (HCR) with different techniques and coronary artery bypass grafting (CABG). METHODS Twenty-three studies were included, covering 10 468 different patients, among whom 2403 patients underwent HCR with either simultaneous or staged method and 8065 patients underwent CABG. RESULTS Compared with CABG, HCR had a statistically significant lower risk of stroke [odds ratio (OR) = 0.55, P = 0.049], major adverse cardiac and cerebrovascular events (OR = 0.69, P = 0.024) and blood transfusion (BT) (OR = 0.39, P < 0.001), whereas no significant differences were detected in mortality, myocardial infarction and repeat revascularization. A network meta-analysis showed that simultaneous HCR had significantly better outcomes in stroke (OR = 0.24, P = 0.01) and major adverse cardiac and cerebrovascular events (OR = 0.29, P < 0.001), and staged HCR had a significantly better outcome in BT (OR = 0.31, P < 0.001). According to the frequentist statistic results, simultaneous HCR had the highest probability of being the best treatment in terms of mortality (84%), stroke (97%), myocardial infarction (88%) and major adverse cardiac and cerebrovascular events (99%), whereas staged HCR had the highest probability of being the best in postoperative repeat revascularization (59%) and BT (83%). However, long-term results showed no significant difference between the HCR and CABG techniques. CONCLUSIONS HCR appears to be a feasible option for multivessel coronary artery disease patients. Compared to traditional CABG, HCR had lower risk of adverse events in the short term, but in the long term, survival rate and freedom from major adverse cardiac and cerebrovascular events rate were similar between groups.
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Affiliation(s)
- Chuan Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ping Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fan Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jingxing Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Qingyu Kong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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10
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Abstract
Combined surgical and percutaneous coronary revascularization, ie, hybrid coronary revascularization (HCR) consists of surgical left internal mammary artery (LIMA) bypass to the left anterior descending artery (LAD) and percutaneous revascularization of other diseased coronary arteries. Developed as a 1-stage procedure, HCR has not been widely adopted by the cardiovascular community. The recommended minimally invasive approach through a small left thoracotomy incision is technically demanding, and same-day percutaneous revascularization requires a hybrid operating room that is not available in most hospitals. In this review, we consider present HCR protocols, barriers to widespread adoption of HCR, and we give special attention to the surgical approach for the LIMA graft to the LAD and the timing of percutaneous revascularization. We conclude that grafting the LIMA to the LAD through a median sternotomy approach and delaying the percutaneous revascularization may facilitate the widespread use of HCR in patients with multivessel coronary artery disease and a low to intermediate Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score.
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11
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Bithas C, Harky A. Advances in revascularization of the left coronary artery. Coron Artery Dis 2021; 32:247-255. [PMID: 33587357 DOI: 10.1097/mca.0000000000001005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ischaemic heart disease is the most common cardiovascular disease worldwide, and it contributes to a significant source of morbidity and mortality internationally. It can be asymptomatic for many years and present suddenly with acute coronary syndrome or can be progressive with angina and eventual acute myocardial infarction. Diseases of the left coronary system can be drastic and fatal if not managed correctly. With ongoing increase in the practice of percutaneous intervention; patient demographics for conventional coronary artery bypass grafting surgery have more risk factors than before. Conventional bypass surgery has also evolved to include minimally invasive and hybrid techniques. Although some evidence supports each approach, controversies remain.
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Affiliation(s)
- Christiana Bithas
- Department of Respiratory medicine, Southport and Ormskirk Hospital NHS Trust, Southport PR8 6PN
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
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Zhu P, Qiu J, Xu H, Liu J, Zhao Q. Hybrid coronary revascularization versus total arterial revascularization for the treatment of left main coronary artery disease. Ann Transl Med 2021; 9:285. [PMID: 33708912 PMCID: PMC7944322 DOI: 10.21037/atm-20-4224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Hybrid coronary revascularization (HCR) has a similar clinical outcome to coronary artery bypass grafting (CABG) in treating multivessel disease. However, the outcome of HCR in treating left main coronary artery (LM) disease is unclear. This study sought to compare the clinical outcome of HCR with total arterial revascularization (TAR) for treating LM disease. Methods Patients who underwent treatment for LM disease in our center between January 2009 and December 2019 were selected. Of these, 33 patients underwent HCR, and 70 patients underwent TAR. The primary efficacy outcome of this study was mid-term major adverse cardiac and cerebrovascular events (MACCE). The primary safety outcome was perioperative MACCE. Results The incidence of postoperative outcomes was comparable between the two groups after adjustment with inverse probability weighting (IPW) (P>0.05). The median follow-up time was 47 (interquartile range, 20 to 85) months. There was no significant difference in the incidence of all mid-term outcomes and the freedom of MACCE between the two groups after adjustment (P>0.05). The Cox proportional hazard model demonstrated that HCR was not a significant determinant for MACCE [hazard ratio (HR) =3.516, 95% confidence interval (CI): 0.835 to 14.813]. Conclusions HCR may be safe and effective for the treatment of LM disease compared with TAR.
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Affiliation(s)
- Pengxiong Zhu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiapei Qiu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hong Xu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Liu
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiang Zhao
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
Minimally invasive cardiac surgery options, which originated with off-pump coronary artery bypass grafting and aortic valve procedures, continue to evolve in order to address complex conditions, including those requiring mitral and tricuspid valve repair. Although these procedures are primarily indicated for high-risk patient populations, favorable patient outcomes have resulted in recommendations being expanded to include intermediate-risk groups. This article increases nursing-related knowledge of minimally invasive cardiac procedures, providing an overview of current minimally invasive cardiac surgeries and their associated risks and benefits.
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Affiliation(s)
- Sharon Wahl
- Sharon Wahl is a clinical nurse specialist at Abbott Northwestern Hospital, Minneapolis, Minnesota
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14
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Hannan EL, Wu Y, Cozzens K, Sundt TM, Girardi L, Chikwe J, Wechsler A, Smith CR, Gold JP, Lahey SJ, Jordan D. Hybrid Coronary Revascularization Versus Conventional Coronary Artery Bypass Surgery: Utilization and Comparative Outcomes. Circ Cardiovasc Interv 2020; 13:e009386. [PMID: 33040581 DOI: 10.1161/circinterventions.120.009386] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) treats multivessel coronary artery disease by combining a minimally invasive surgical approach to the left anterior descending artery with percutaneous coronary intervention for non-left anterior descending diseased coronary arteries. The objective of this study is to compare HCR and conventional coronary artery bypass graft (CABG) surgery medium-term outcomes. METHODS Data from multivessel disease patients in New York's cardiac surgery and percutaneous coronary intervention registries in 2010 to 2016 were used to compare mortality and repeat revascularization rates for HCR and conventional CABG after using propensity matching to reduce selection bias. RESULTS There was a total of 303 HCR (0.80%) patients and 37 556 conventional CABG patients after exclusions. After propensity matching, the respective median follow-up times were 3.72 years and 3.76 years. There was no difference between HCR and conventional CABG in survival at 6 years (80.9% versus 85.8%%, adjusted hazard ratio, 1.44 [0.90-2.31]), but HCR had higher mortality excluding deaths during the first year (adjusted hazard ratio, 1.88 [1.10-3.23]). Conventional CABG patients were more likely to be free from repeat revascularization at 6 years than HCR patients (88.2% versus 76.6%; hazard ratio, 2.22 [1.44-3.42]). CONCLUSIONS HCR is rarely performed for patients with multivessel coronary artery disease. HCR and conventional CABG had no different 6-year mortality rates, but HCR had higher mortality after 1 year and higher rates of subsequent revascularization that were caused by both the need for repeat revascularization in the left anterior descending artery where minimally invasive CABG was performed, and in the coronary arteries where percutaneous coronary intervention was performed. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Edward L Hannan
- School of Public Health, University at Albany, State University of New York, NY (E.L.H., Y.W., K.C.)
| | - Yifeng Wu
- School of Public Health, University at Albany, State University of New York, NY (E.L.H., Y.W., K.C.)
| | - Kimberly Cozzens
- School of Public Health, University at Albany, State University of New York, NY (E.L.H., Y.W., K.C.)
| | - Thoralf M Sundt
- Cardiac Surgical Division, Massachusetts General Hospital, Boston (T.M.S.)
| | - Leonard Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical Center, NY (L.G.)
| | - Joanna Chikwe
- Department of Cardiac Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (J.C.)
| | - Andrew Wechsler
- Department of Cardiothoracic Surgery, Drexel University, Philadelphia, PA (A.W.)
| | - Craig R Smith
- Department of Surgery, Columbia-Presbyterian Medical Center, NY (C.R.S.)
| | - Jeffrey P Gold
- Chancellor, University of Nebraska Medical Center, Omaha, NE (J.P.G.)
| | - Stephen J Lahey
- Division of Cardiothoracic Surgery, University of Connecticut, Storrs (S.J.L.)
| | - Desmond Jordan
- Department of Anesthesiology, Columbia-Presbyterian Medical Center, NY (D.J.)
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Alahdab F, Zuhri Yafi R, Chaar A, Alrstom A, Alzuabi M, Alhalabi O, Hasan S, Mallak M, Jazayerli ML, Haydour Q, Alkhouli M, Alfarkh W, Murad MH. Aspirin dosage for the prevention of graft occlusion in people undergoing coronary surgery: A systematic review and meta-analysis. Avicenna J Med 2020; 10:198-207. [PMID: 33437691 PMCID: PMC7791283 DOI: 10.4103/ajm.ajm_17_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Aspirin is almost always used after coronary artery bypass graft (CABG) surgery; however, it is unclear what optimal dose should be prescribed. In this systematic review, we evaluated the effects of high versus low-dose aspirin in patients after CABG. Methods: A comprehensive database search was conducted in several databases from date of inception until February 2018. There were no language restrictions. We included studies that compared different doses of aspirin in patients that had undergone CABG surgery. We included studies that evaluated patient-important outcomes (mortality, cardiovascular events, and gastrointestinal bleeding); and if not reported, we collected data on the surrogate outcome thromboxane B2 (TXB2). We collected relevant data and performed a meta-analysis. Results: We identified 5903 references, and after two levels of screening by two independent reviewers, we included three randomized controlled trials in the meta-analysis with a total number of 122 participants. Mean age of trial participants was 65.63 years, and 88.68% were male. We planned to analyze all possible clinical outcomes, including mortality, recurrence, and hospitalization. However, no clinical outcomes are reported by the literature. The surrogate biochemical outcome of serum TXB2 was the only outcome reported by the eligible studies. High-dose aspirin (162–325mg once daily) achieved better suppression of TXB2 than low-dose aspirin (75–100mg once daily) (mean difference [MD], 2.00ng/mL, 95% confidence interval [CI]: 0.72–3.32; participants = 122; studies = 3; I2 = 0%). Conclusions: We found no clinical trials addressing any of the clinical outcomes of interest. High-dose aspirin was superior to low-dose aspirin in suppressing platelet function, a surrogate outcome. Trials evaluating clinical and patient-important outcomes are needed to better inform medical practice and fill this gap in clinical knowledge.
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Affiliation(s)
- Fares Alahdab
- Evidence-based Practice Center, Mayo Clinic, Rochester, Michigan, USA
| | - Ruba Zuhri Yafi
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Abdelkader Chaar
- Department of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Ali Alrstom
- Department of Medicine, Damascus University, Almwasat Hospital, Damascus, Syrian Arab Republic
| | - Muayad Alzuabi
- Department of Neurology, Medical University of South Carolina, Charleston, South Carolina
| | - Omar Alhalabi
- Division of Cancer Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Somar Hasan
- Department of Ophthalmology, Jena University Hospital, Jena, Germany
| | - Mahmoud Mallak
- Children's University Hospital, Damascus, Syrian Arab Republic
| | | | - Qusay Haydour
- Department of Internal Medicine, Cleveland Clinic Akron General, Akron, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Michigan, USA
| | - Wedad Alfarkh
- Department of Pathology, Baylor College of Medicine, Rochester, Michigan, USA
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Maskell P, Oo S, Muir AD, Fan KS, Harky A. Techniques and approaches for revascularisation of left heart coronary diseases. Br J Hosp Med (Lond) 2020; 81:1-11. [PMID: 32845756 DOI: 10.12968/hmed.2020.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Coronary artery disease and its associated clinical sequelae are a significant medical burden to clinicians and patients. Severe coronary artery disease presenting in the context of acute myocardial ischaemia, or stable plaques causing chronic symptoms despite best conservative and pharmacological intervention, are often amenable to further intervention such as coronary artery bypass grafting. This procedure has been extensively compared to newer and less invasive techniques, such as percutaneous coronary intervention, and other minimally invasive procedures such as robotic or endoscopic techniques. This review summarises the current evidence on revascularisation of the left coronary artery system, with particular emphasis on key clinical endpoints of mortality, myocardial infarction, stroke and repeat revascularisation.
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Affiliation(s)
- Perry Maskell
- Department of Medical Education, Countess of Chester Hospital, Chester, UK
| | - Shwe Oo
- Department of Cardiothoracic Surgery, Bristol Royal Infirmary, Bristol, UK
| | - Andrew D Muir
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK
| | - Ka Siu Fan
- St. George's Medical School, University of London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest, Liverpool, UK.,Institute of Integrative Biology, University of Liverpool, Liverpool, UK
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Hage A, Giambruno V, Jones P, Chu MW, Fox S, Teefy P, Lavi S, Bainbridge D, Harle C, Iglesias I, Dobkowski W, Kiaii B. Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting: Comparative Effectiveness Analysis With Long-Term Follow-up. J Am Heart Assoc 2019; 8:e014204. [PMID: 31826727 PMCID: PMC6951054 DOI: 10.1161/jaha.119.014204] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hybrid coronary revascularization (HCR) involves the integration of coronary artery bypass grafting (CABG) and percutaneous coronary intervention to treat multivessel coronary artery disease. Our objective was to perform a comparative analysis with long-term follow-up between HCR and conventional off-pump CABG. Methods and Results We compared all double off-pump CABG (n=216) and HCR (n=147; robotic-assisted minimally invasive direct CABG of the left internal thoracic artery to the left anterior descending artery and percutaneous coronary intervention to one of the non-left anterior descending vessels) performed at a single institution between March 2004 and November 2015. To adjust for the selection bias of receiving either off-pump CABG or HCR, we performed a propensity score analysis using inverse-probability weighting. Both groups had similar results in terms of re-exploration for bleeding, perioperative myocardial infarction, stroke, blood transfusion, in-hospital mortality, and intensive care unit length of stay. HCR was associated with a higher in-hospital reintervention rate (CABG 0% versus HCR 3.4%; P=0.03), lower prolonged mechanical ventilation (>24 hours) rate (4% versus 0.7%; P=0.02), and shorter hospital length of stay (8.1±5.8 versus 4.5±2.1 days; P<0.001). After a median follow-up of 81 (48-113) months for the off-pump CABG and 96 (53-115) months for HCR, the HCR group of patients had a trend toward improved survival (85% versus 96%; P=0.054). Freedom from any form of revascularization was similar between the 2 groups (92% versus 91%; P=0.80). Freedom from angina was better in the HCR group (73% versus 90%; P<0.001). Conclusions HCR seems to provide, in selected patients, a shorter postoperative recovery, with similar excellent short- and long-term outcomes when compared with standard off-pump CABG.
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Affiliation(s)
- Ali Hage
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Vincenzo Giambruno
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Philip Jones
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Michael W Chu
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Stephanie Fox
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
| | - Patrick Teefy
- Division of Cardiology Department of Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Shahar Lavi
- Division of Cardiology Department of Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Christopher Harle
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Ivan Iglesias
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Woijtecj Dobkowski
- Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada
| | - Bob Kiaii
- Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada
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Leyvi G, Dabas A, Leff JD. Hybrid Coronary Revascularization - Current State of the Art. J Cardiothorac Vasc Anesth 2019; 33:3437-3445. [DOI: 10.1053/j.jvca.2019.08.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 11/11/2022]
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Abstract
OBJECTIVE The role of hybrid coronary revascularization (HCR), which utilizes the combination of minimally invasive surgical coronary artery bypass grafting of the left anterior descending artery and percutaneous coronary intervention (PCI) of non-left anterior descending vessels to treat multivessel coronary artery disease, is expanding. We set out to provide a review of this technology. METHODS We conducted a retrospective analysis of all minimally invasive hybrid operations performed at our institution from September 2004 to December 2018. An effective analysis comparing patients undergoing HCR vs off-pump or on-pump surgical coronary artery revascularization was undertaken using an adjusted analysis with inverse-probability weighting based on the propensity score. Outcomes that were assessed include death, myocardial infarction, stroke, atrial fibrillation, renal failure, requirement of blood transfusion, conversion to open procedure (in the hybrid group), length of stay in intensive care unit, and total length of stay in hospital. Intention-to-treat analysis was performed. An up-to-date literature review of HCR complements this study. RESULTS Since 2004 a total of 191 consecutive patients (61.4±11.1 years; 142 males and 49 females) underwent HCR (robotic-assisted coronary artery bypass graft of the left internal thoracic artery to the left anterior descending coronary artery (LAD) and PCI of a non-LAD vessel) in a single- or double-stage fashion. Successful HCR occurred in 183 of the 191 patients (8 patients required intraoperative conversion to conventional coronary bypass). From our comparative analysis and literature review we found no significant difference between HCR and coronary artery bypass grafting groups with respect to in-hospital and 1-year follow-up. CONCLUSIONS Current evidences suggest that HCR is a feasible, safe, and effective coronary artery revascularization strategy in selected patients with multivessel coronary artery disease.
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Affiliation(s)
- Bob Kiaii
- Department of Cardiac Surgery, London Health Sciences Centre, London, ON, Canada
| | - Patrick Teefy
- Department of Cardiology, London Health Sciences Centre, London, ON, Canada
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Repossini A, Di Bacco L, Rosati F, Tespili M, Saino A, Ielasi A, Muneretto C. Hybrid coronary revascularization versus percutaneous strategies in left main stenosis: a propensity match study. J Cardiovasc Med (Hagerstown) 2018. [PMID: 29517516 DOI: 10.2459/jcm.0000000000000641] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Hybrid revascularization (HCR) has been recently proposed as an alternative strategy in multivessel coronary disease, particularly in patients with high SYNTAX scores and risk scores. The objective of this study is to evaluate the outcomes of HCR versus percutaneous coronary intervention (PCI) drug-eluting stenting in left main treatment. METHODS A series of 198 consecutive patients with left main stenosis have been treated. HCR, was performed in 77 patients (G1) whereas 121 patients (G2) received PCI on left main. An adjusted analysis using inverse probability weighting (IPW) was performed. Primary outcomes include: 30-day mortality, postoperative acute myocardial infarction, 18 months' MACCEs: cardiac death, stroke, acute myocardial infarction (AMI), repeated target vessel revascularization (TVR). RESULTS SYNTAX score was 29.5 ± 6.9 in G1 and 29.1 ± 6.5 in G2 (P = 0.529). In G2, three patients (2.7%) died because of cardiogenic shock; no deaths occurred in G1 (P = 0.603). No major complications were reported in G1 and there was no mortality at 18 months' follow-up in both groups. Survival freedom from MACCEs at 18 months' follow-up was significantly higher in G1 (G1: 93.3 ± 4.6% versus G2: 72.3 ± 6.3; P = 0.001) mostly because of the higher freedom from TVR (G1: 93.3 ± 4.6% versus G2: 75.5 ± 5.6; P = 0.002). At Cox regression analysis, PCI was an independent predictor of MACCEs and TVR (hazard ratio 3.9, CI 1.36-9.6; P = 0.027). CONCLUSION PCI in patients with left main and multivessel disease is a viable strategy, with a good outcome. HCR, demonstrated a lower incidence of cardiac adverse events such as AMI and TVR. Future comparative studies will be helpful to identify the optimal patient population for HCR.
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Affiliation(s)
- Alberto Repossini
- Clinical Department of Cardiovascular Surgery, Cardiac Surgery Unit ,University of Brescia
| | - Lorenzo Di Bacco
- Clinical Department of Cardiovascular Surgery, Cardiac Surgery Unit ,University of Brescia
| | - Fabrizio Rosati
- Clinical Department of Cardiovascular Surgery, Cardiac Surgery Unit ,University of Brescia
| | | | | | | | - Claudio Muneretto
- Clinical Department of Cardiovascular Surgery, Cardiac Surgery Unit ,University of Brescia
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Patel NC, Hemli JM, Kim MC, Seetharam K, Pirelli L, Brinster DR, Scheinerman SJ, Singh VP. Short- and intermediate-term outcomes of hybrid coronary revascularization for double-vessel disease. J Thorac Cardiovasc Surg 2018; 156:1799-1807.e3. [DOI: 10.1016/j.jtcvs.2018.04.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/12/2018] [Accepted: 04/17/2018] [Indexed: 11/16/2022]
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Abstract
BACKGROUND Hybrid coronary revascularization (HCR) combining minimally invasive grafting of the left internal mammary artery to the left anterior descending artery with percutaneous coronary intervention has become a viable option for treating coronary artery disease. The aim of this meta-analysis was to compare HCR with conventional coronary artery bypass grafting (CABG) in a range of clinical outcomes and hospital costs. METHODS To identify potential studies, systematic searches were carried out in various databases. The key search terms included "hybrid revascularization" AND "coronary artery bypass grafting" OR "HCR" OR "CABG." This was followed by a meta-analysis investigating the need for blood transfusion, hospital costs, ventilation time, hospital stay, cerebrovascular accident, myocardial infarction, mortality, postoperative atrial fibrillation, renal failure, operation duration, and ICU stay. RESULTS The requirement for blood transfusion was significantly lower for HCR: odds ratio 0.38 (95% confidence intervals [CIs] 0.31-0.46, P < .00001) as was the hospital stay: mean difference (MD) -1.48 days (95% CI, -2.61 to -0.36, P = 0.01) and the ventilation time: MD -8.99 hours (95% CI, -15.85 to -2.13, P = .01). On the contrary, hospital costs were more expensive for HCR: MD $3970 (95% CI, 2570-5370, P < .00001). All other comparisons were insignificant. CONCLUSIONS In the short-term, HCR is as safe as conventional CABG and may offer certain benefits such as a lower requirement for blood transfusion and shorter hospital stays. However, HCR is more expensive than conventional CABG.
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Abstract
Hybrid coronary revascularization (HCR) combines surgical bypass with percutaneous coronary intervention (PCI) performed either during the same procedure or in a staged approach within 60 days. Coronary artery bypass grafting using the left internal mammary artery (LIMA) has shown excellent long-term patency with improved patient survival. It remains the gold standard treatment for the majority of patients with multivessel coronary artery disease. However, saphenous vein grafts have poor long-term patency. Advances in stent technology have resulted in reduced rates of thrombosis and restenosis, making PCI a viable alternative to coronary surgery in selected patients. HCR is attractive as a less invasive method of coronary revascularization which preserves the benefits of the LIMA performed with less invasive surgical techniques with the efficacy of newer generation stents.
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Giambruno V, Jones P, Khaliel F, Chu MW, Teefy P, Sridhar K, Cucchietti C, Barnfield R, Kiaii B. Hybrid Coronary Revascularization Versus On-Pump Coronary Artery Bypass Grafting. Ann Thorac Surg 2018; 105:1330-1335. [DOI: 10.1016/j.athoracsur.2017.11.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 10/03/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022]
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Xia Y, Katz AN, Forest SJ, Pyo RT, Greenberg MA, DeRose JJ Jr. Hybrid Coronary Revascularization has Improved Short-term Outcomes but Worse Mid-term Reintervention Rates Compared to CABG: A Propensity Matched Analysis. Innovations (Phila) 2017; 12:174-9. [PMID: 28549028 DOI: 10.1097/IMI.0000000000000376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We evaluated short-term outcomes and mid-term survival and reintervention of hybrid coronary revascularization versus conventional coronary artery bypass grafting using a propensity score matched cohort. METHODS We conducted a retrospective review of patients undergoing surgery for multivessel coronary artery disease from 2007 to 2015 at a single institution. Patients were propensity matched 1:1 to receiving hybrid coronary revascularization or conventional bypass grafting by multivariate logistic regression on preoperative characteristics. Short-term outcomes were compared. Freedom from reintervention and death were assessed by Kaplan-Meier analysis, log-rank test, and Cox proportional hazards regression. RESULTS Propensity score matching selected 91 patients per group from 91 hybrid and 2601 conventionally revascularized patients. Hybrid revascularization occurred with surgery first in 56 (62%), percutaneous intervention first in 32 (35%), and simultaneously in 3 (3%) patients. Median intervals between interventions were 3 and 36 days for surgery first and percutaneous intervention first, respectively. Preoperative characteristics were similar. Patients undergoing hybrid revascularization had shorter postoperative length of stay (median = 4 vs 5 days, P < 0.001), less postoperative transfusion (13.2% vs 34.1%, P = 0.001), and respiratory failure (0% vs 6.6%, P = 0.03). They were more likely to be discharged home (93.4% vs 71.4%, P < 0.001), with no difference in 30-day mortality (P = 0.99), readmission (P = 0.23), or mid-term survival (P = 0.79). Hybrid revascularization was associated with earlier reintervention (P = 0.02). Hazard ratios for reintervention and patient mortality of hybrid coronary revascularization versus conventional revascularization were 3.60 (95% confidence interval = 1.16-11.20) and 1.17 (95% confidence interval = 0.37-3.72), respectively. CONCLUSIONS Despite having favorable short-term outcomes and similar survival, hybrid coronary revascularization may be associated with earlier reintervention compared with conventional techniques.
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Misumida N, Moliterno DJ. Hybrid coronary revascularization: Time for a new comparator? Catheter Cardiovasc Interv 2018; 91:213-214. [PMID: 29405596 DOI: 10.1002/ccd.27503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/03/2018] [Indexed: 11/10/2022]
Abstract
The present meta-analysis found no significant difference between hybrid coronary revascularization (HCR) and bypass surgery (CABG) regarding intermediate-term major adverse cardiac and cerebrovascular events. HCR is feasible, historically with higher revascularization rates but less perioperative morbidity With a comparable frequency of repeat revascularization between current-generation drug-eluting stents and CABG, future trials of HCR are considering multi-vessel PCI as the new comparator.
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Affiliation(s)
- Naoki Misumida
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
| | - David J Moliterno
- Gill Heart Institute and Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky
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Easterwood RM, Bostock IC, Nammalwar S, McCullough JN, Iribarne A. The evolution of minimally invasive cardiac surgery: from minimal access to transcatheter approaches. Future Cardiol 2017; 14:75-87. [PMID: 29199850 DOI: 10.2217/fca-2017-0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The field of minimally invasive cardiac surgery has undergone rapid transformation over recent years. In this review, we provide a summary of the most current evidence supporting the use of minimally invasive aortic and mitral valve replacement techniques, as well as transcatheter approaches for aortic and mitral valve disease. As an adjunct, the use of robotically assisted coronary bypass surgery and hybrid coronary revascularization procedures is discussed. In order to obtain optimal patient outcomes, a collaborative, heart-team approach between cardiac surgeons and interventional cardiologists is necessary.
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Affiliation(s)
- Rachel M Easterwood
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | - Ian C Bostock
- Heart & Vascular Center, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Shruthi Nammalwar
- Heart & Vascular Center, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Jock N McCullough
- Heart & Vascular Center, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA
| | - Alexander Iribarne
- Heart & Vascular Center, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03766, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH 03766, USA
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Abstract
Heart failure (HF) remains the leading cause of hospitalization in older adults and is associated with increased morbidity and mortality despite the use of guideline-directed medical therapy. There has been tremendous progress in the development of novel transcatheter and interventional therapies for HF over the past decade. The evolution of structural heart disease interventions and interventional HF has led to a multidisciplinary heart team approach in the management of HF patients. Careful selection of the appropriate patient population and end points in future randomized controlled trials will be crucial to demonstrate the potential efficacy of the novel interventional HF therapies.
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Affiliation(s)
- Dhaval Kolte
- Division of Cardiovascular Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Jinnette Dawn Abbott
- Division of Cardiovascular Medicine, Brown University, 593 Eddy Street, Providence, RI 02903, USA
| | - Herbert D Aronow
- Division of Cardiovascular Medicine, The Warren Alpert Medical School of Brown University, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA.
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30
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Sardar P, Kundu A, Bischoff M, Chatterjee S, Owan T, Nairooz R, Giri J, Halkos ME, Liberman H, Douglas JS, Mukherjee D. Hybrid coronary revascularization versus coronary artery bypass grafting in patients with multivessel coronary artery disease: A meta-analysis. Catheter Cardiovasc Interv 2017; 91:203-212. [DOI: 10.1002/ccd.27098] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/16/2017] [Accepted: 03/23/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Partha Sardar
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Amartya Kundu
- Department of Medicine; University of Massachusetts Medical School; Worcester Massachusetts
| | | | - Saurav Chatterjee
- Division of Cardiovascular Medicine; Temple University School of Medicine; Philadelphia Pennsylvania
| | - Theophilus Owan
- Division of Cardiovascular Medicine; University of Utah; Salt Lake City Utah
| | - Ramez Nairooz
- Division of Cardiovascular Medicine; University of Arkansas for Medical Sciences; Little Rock Arkansas
| | - Jay Giri
- Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Michael E. Halkos
- Division of Cardiothoracic Surgery; Emory University School of Medicine; Atlanta Georgia
| | - Henry Liberman
- Clinical Research Unit, Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - John S. Douglas
- Clinical Research Unit, Division of Cardiology; Emory University School of Medicine; Atlanta Georgia
| | - Debabrata Mukherjee
- Division of Cardiovascular Medicine; Texas Tech University Health Sciences Center; El Paso Texas
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31
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Xia Y, Katz AN, Forest SJ, Pyo RT, Greenberg MA, DeRose JJ. Hybrid Coronary Revascularization Has Improved Short-Term Outcomes but Worse Mid-Term Reintervention Rates Compared to Cabg. Innovations 2017. [DOI: 10.1177/155698451701200302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Yu Xia
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY USA
| | - Abraham N. Katz
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY USA
| | - Stephen J. Forest
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY USA
| | - Robert T. Pyo
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - Mark A. Greenberg
- Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, NY USA
| | - Joseph J. DeRose
- Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center, Bronx, NY USA
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32
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Giambruno V, Hafiz A, Fox SA, Jeanmart H, Cook RC, Khaliel FH, Teefy P, Sridhar K, Lavi S, Bagur R, Randhawa VK, Iglesias I, Jones PM, Harle CC, Bainbridge D, Chu MWA, Kiaii BB. Is the Future of Coronary Arterial Revascularization a Hybrid Approach? Innovations 2017. [DOI: 10.1177/155698451701200202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vincenzo Giambruno
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Ahmad Hafiz
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Stephanie A. Fox
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Hugues Jeanmart
- Division of Cardiac Surgery, University of Montreal, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Richard C. Cook
- Division of Cardiac Surgery, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Feras H. Khaliel
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Patrick Teefy
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Kumar Sridhar
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Shahar Lavi
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Varinder K. Randhawa
- Division of Cardiology, Department of Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Ivan Iglesias
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Philip M. Jones
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Christopher C. Harle
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Daniel Bainbridge
- Department of Anesthesia and Perioperative Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Michael W. A. Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Bob B. Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London Health Sciences Centre, London, Ontario, Canada
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33
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Giambruno V, Hafiz A, Fox SA, Jeanmart H, Cook RC, Khaliel FH, Teefy P, Sridhar K, Lavi S, Bagur R, Randhawa VK, Iglesias I, Jones PM, Harle CC, Bainbridge D, Chu MWA, Kiaii BB. Is the Future of Coronary Arterial Revascularization a Hybrid Approach?: The Canadian Experience across three Centers. Innovations�(Phila) 2017; 12:82-6. [DOI: 10.1097/imi.0000000000000355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective Hybrid coronary revascularization offers and combines the advantages of both surgical and percutaneous revascularization and eliminates at the same time the disadvantages of both procedures. The objective of this study was to assess graft and stent patency at 6 months, rate of bleeding, intensive care unit and hospital stay, rate of reintervention, and long-term clinical follow-up. Methods From March 2004 to November 2015, a total of 203 patients underwent robotic-assisted minimally invasive direct coronary artery bypass graft of the left internal thoracic artery to the left anterior descending artery and PCI of a non-left anterior descending vessel in a single or two stage, at three different centers. Patients underwent 6-month angiographic follow-up. The mean ± SD clinical follow-up was 77.82 ±41.4 months. Results Successful hybrid coronary revascularization occurred in 196 of the 203 patients. One hundred forty-six patients underwent simultaneous surgical and percutaneous intervention. Nineteen patients underwent PCI before surgery, and 38 patient underwent PCI after surgery. No in-hospital mortality occurred. The mean ± SD ICU stay was 1 ± 1 days and the mean ± SD hospital stay was 5 ± 2 days. Only 13.3% of the patients required a blood transfusion. Six-month angiographic follow-up has been performed in the 95 patients, and it demonstrated a left internal thoracic artery anastomotic patency of 97.9% and stent patency of 92.6%. A total of 77.8 ± 41.4-month clinical follow-up demonstrated 95.1% survival, 92.6% freedom from angina, and 90.7% freedom from any form of coronary revascularization. Conclusions Hybrid coronary revascularization seems to be a promising and safe revascularization strategy. It provides selected patients with an alternative, functionally complete revascularization with minimal surgical trauma and good long-term clinical outcomes.
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Affiliation(s)
- Gianluca Torregrossa
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Yumiko Kanei
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
| | - John Puskas
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, NY, USA
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35
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Doenst T, Strüning C, Moschovas A, Gonzalez-Lopez D, Essa Y, Kirov H, Diab M, Faerber G. Cardiac surgery 2015 reviewed. Clin Res Cardiol 2016; 105:801-14. [PMID: 27357709 DOI: 10.1007/s00392-016-1013-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 06/16/2016] [Indexed: 01/14/2023]
Abstract
For the year 2015, almost 19,000 published references can be found in PubMed when entering the search term "cardiac surgery". The last year has been again characterized by lively discussions in the fields where classic cardiac surgery and modern interventional techniques overlap. Lacking evidence in the field of coronary revascularization with either percutaneous coronary intervention or bypass surgery has been added. As in the years before, CABG remains the gold standard for the revascularization of complex stable triple-vessel disease. Plenty of new information has been presented comparing the conventional to transcatheter aortic valve implantation (TAVI) demonstrating similar short- and mid-term outcomes at high and low risk, but even a survival advantage with transfemoral TAVI at intermediate risk. In addition, there were many relevant and interesting other contributions from the purely operative arena. This review article will summarize the most pertinent publications in the fields of coronary revascularization, surgical treatment of valve disease, heart failure (i.e., transplantation and ventricular assist devices), and aortic surgery. While the article does not have the expectation of being complete and cannot be free of individual interpretation, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.
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36
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Whitson BA, Lima B. Surgery for acquired cardiac disease: An evolving paradigm with a promising future. J Thorac Cardiovasc Surg 2016; 151:1466-9. [PMID: 27207120 DOI: 10.1016/j.jtcvs.2016.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/16/2015] [Accepted: 01/05/2016] [Indexed: 11/22/2022]
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37
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Rosenblum JM, Harskamp RE, Hoedemaker N, Walker P, Liberman HA, de Winter RJ, Vassiliades TA, Puskas JD, Halkos ME. Hybrid coronary revascularization versus coronary artery bypass surgery with bilateral or single internal mammary artery grafts. J Thorac Cardiovasc Surg 2016; 151:1081-9. [DOI: 10.1016/j.jtcvs.2015.10.061] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 10/19/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
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38
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Alahdab F, Jazayerli ML, Alhalabi O, Hasan S, Mallak M, Alkhouli M, Haydour Q, Murad MH. Aspirin dosage for the prevention of graft occlusion in people undergoing coronary surgery. Hippokratia 2016. [DOI: 10.1002/14651858.cd012113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Fares Alahdab
- Mayo Clinic; Evidence-based Practice Center; 1919 3rd Ave NE Apt 2 Rochester MN USA 55906
| | - Mhd Luay Jazayerli
- University of Damascus; Faculty of Medicine; Damascus Syrian Arab Republic
| | - Omar Alhalabi
- University of Damascus; Faculty of Medicine; Damascus Syrian Arab Republic
| | - Somar Hasan
- Damascus University; Almwasat University Hospital; Damascus Syrian Arab Republic
| | - Mahmoud Mallak
- University of Damascus; Children's University Hospital; Damascus Syrian Arab Republic
| | | | - Qusay Haydour
- University of Damascus; Faculty of Medicine; Damascus Syrian Arab Republic
| | - M. Hassan Murad
- Mayo Clinic; Preventive Medicine Fellowship, The Knowledge and Encounter Research Unit; 200 First Street SW Rochester MN USA 55905
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39
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D'Ancona G, Kische S, Ince H. Off-pump versus on-pump coronary artery bypass grafting in patients with depressed left ventricular ejection fraction percentage: "If this is the best of all possible worlds, what then are the others?". J Thorac Cardiovasc Surg 2016; 151:1099-100. [PMID: 26778213 DOI: 10.1016/j.jtcvs.2015.11.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 11/30/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Giuseppe D'Ancona
- Vivantes Klinikum im Friedrichshain und Am Urban, Berlin and Rostock University Medical Center, Rostock, Germany; Rostock University Medical Center, Rostock, Germany.
| | - Stephan Kische
- Vivantes Klinikum im Friedrichshain und Am Urban, Berlin and Rostock University Medical Center, Rostock, Germany; Rostock University Medical Center, Rostock, Germany
| | - Hüseyin Ince
- Vivantes Klinikum im Friedrichshain und Am Urban, Berlin and Rostock University Medical Center, Rostock, Germany; Rostock University Medical Center, Rostock, Germany
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40
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Hiesinger W, Atluri P. Hybrid coronary revascularization: Ready for prime time, but who should star? J Thorac Cardiovasc Surg 2016; 151:1090-1. [PMID: 26809426 DOI: 10.1016/j.jtcvs.2015.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 11/23/2022]
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41
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Abstract
Ischemic mitral regurgitation (IMR) is a complicated medical condition with varying degrees of coronary artery disease and mitral regurgitation (MR). The traditional surgical treatment option for those with indications for intervention is coronary artery bypass grafting (CABG) plus or minus mitral valve repair or replacement (MVR). Percutaneous coronary intervention, hybrid coronary revascularization (HCR), and conventional CABG are three techniques available to address coronary artery disease (CAD). Percutaneous edge-to-edge repair, minimally invasive, and traditional sternotomy are accepted approaches for the treatment of MR. When taken in combination, there are nine methods available to revascularize the myocardium and restore competency to the mitral valve. While most of these treatment options have not been studied in detail, they may offer novel solutions to a widely variable and complex IMR patient population. Thus, a comparative analysis including an examination of potential benefits and risks will be helpful and potentially allow for more patient-specific treatment strategies.
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Affiliation(s)
- David H Scoville
- Stanford University, Department of Cardiothoracic Surgery, Stanford, California, USA
| | - Jack B H Boyd
- Stanford University, Department of Cardiothoracic Surgery, Stanford, California, USA
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