Therapeutic Efficacy of a Staged Hybrid Technique vs. Coronary Artery Bypass Surgery Grafting in The Treatment of Multi-Vessel Coronary Artery Disease
Keywords:coronary artery disease, coronary artery bypass surgery grafting, staged hybrid technique
Objective: Hybrid coronary revascularization (HCR) integrates the advantages of coronary artery bypass surgery grafting (CABG) and percutaneous coronary intervention (PCI) and provides another effective treatment for multi-vessel coronary artery disease (CAD). This study aimed to investigate the short- and intermediate-term efficacies of a staged hybrid technique vs. CABG in treating older patients with multi-vessel CAD.
Methods: Patients, who received elective revascularization for multi-vessel CAD between May 2016 and May 2018, were recruited. They were divided into the CABG group (N = 38) and HCR group (N = 38). The major adverse cardiovascular and cerebrovascular events (MACCE), including myocardial infarction and stroke, were recorded. The results of death and second revascularization also were recorded.
Results: In this study, 90.1% of patients received follow up for a median time of 24 months. At 60 days after surgery, the cumulative mortality in the CABG group was significantly higher than in the HCR group, but the incidence of second revascularization in the CABG group was markedly lower than in the HCR group. The incidence of MACCE was comparable between the two groups.
Conclusion: In older patients with multi-vessel CAD, the mortality after CABG is higher than after HCR, but the incidence of second revascularization after CABG is lower than after HCR.
Angelini GD, Wilde P, Salerno TA, Bosco G, Calafiore AM. 1996. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet. 347(9003):757-8.
Chieffo A, Magni V, Latib A, Maisano F, Ielasi A, Montorfano M, et al. 2010. 5-year outcomes following percutaneous coronary intervention with drug-eluting stent implantation versus coronary artery bypass surgery graft for unprotected left main coronary artery lesions the Milan experience. JACC Cardiovasc Interv. 3(6):595-601.
Cho YK, Nam CW. 2018. Percutaneous coronary intervention in patients with multi-vessel coronary artery disease: a focus on physiology. Korean J Intern Med. 33(5):851-859.
Corpus RA, House JA, Marso SP, Grantham JA, Huber KC Jr, Laster SB, et al. 2004. Multivessel percutaneous coronary intervention in patients with multivessel disease and acute myocardial infarction. Am Heart J. 148(3):493-500.
Gosev I, Leacche M. 2014. Hybrid coronary revascularization: the future of coronary artery bypass surgery or an unfulfilled promise? Circulation 130:869-71.
Halkos ME, Walker PF, Vassiliades TA, Douglas JS, Devireddy C, Guyton RA, et al. 2014. Clinical and angiographic results after hybrid coronary revascularization. Ann Thorac Surg. 97(2):484-90.
Han YL, Li Y. 2015. Introduction to the European Heart Association and European Association of Cardiothoracic Surgery Guidelines for Cardiac Revascularization. Chin J Prac Int Med. 36-7.
Kiaii B, Teefy P. 2019. Hybrid Coronary Artery Revascularization: A Review and Current Evidence. Innovations (Phila). 14(5):394-404.
Kim KB, Cho KR, Jeong DS. 2008. Midterm angiographic follow-up after off-pump coronary artery bypass surgery: serial comparison using early, 1-year, and 5-year postoperative angiograms. J Thorac Cardiovasc Surg. 135:300-7.
Kon ZN, Brown EN, Tran R, Joshi A, Reicher B, Grant MC, et al. 2008. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass surgery. J Thorac Cardiovasc Surg. 135(2):367-75.
Martin BJ, Buth KJ, Arora RC, Baskett RJ. 2012. Delirium: a cause for concern beyond the immediate postoperative period. Ann Thorac Surg. 93(4):1114-20.
Montrief T, Koyfman A, Long B. 2018. Coronary artery bypass surgery graft surgery complications: A review for emergency clinicians. Am J Emerg Med. 36(12):2289-2297.
Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, et al. 2001. Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med. 344(6):395-402.
Stanicki P, Szarpak J, Wieteska M, Kaczyńska A, Milanowska J. 2020. Postoperative depression in patients after coronary artery bypass surgery grafting (CABG) - a review of the literature. Pol Przegl Chir. 92(5):1-5.
Tarakji KG, Sabik JF 3rd, Bhudia SK, Batizy LH, Blackstone EH. 2011. Temporal onset, risk factors, and outcomes associated with stroke after coronary artery bypass surgery grafting. JAMA. 305(4):381-90.
Wu X, Chen Y, Liu H, Teirstein PS, Kirtane AJ, Ge C, et al. 2010. Comparison of long-term (4-year) outcomes of patients with unprotected left main coronary artery narrowing treated with drug-eluting stents versus coronary-artery bypass grafting. Am J Cardiol. 105(12):1728-34.
Xie Q, Huang J, Zhu K, Chen Q. 2021. Percutaneous coronary intervention versus coronary artery bypass surgery grafting in patients with coronary heart disease and type 2 diabetes mellitus: Cumulative meta-analysis. Clin Cardiol. 44(7):899-906.
Yamamoto K, Matsumura-Nakano Y, Shiomi H, Natsuaki M, Morimoto T, Kadota K, et al. 2021. Effect of Heart Failure on Long-Term Clinical Outcomes After Percutaneous Coronary Intervention Versus coronary artery bypass surgery Grafting in Patients With Severe Coronary Artery Disease. J Am Heart Assoc. 10(15):e021257.
Zhao TY, Bu JQ, Gu JJ, Liu Y, Zhang WL, Chen ZY. 2021. The Short-Term Patency Rate of a Saphenous Vein Bridge Using the No-Touch Technique in off-Pump coronary artery bypass surgery Grafting in Vein Harvesting. Int J Gen Med. 14:2281-2288.
Zhou W, Lu J, Xin J. 2010. Clinical Application of Hybrid Technique in the Treatment of Complex Coronary Heart Disease. Chin Heart J. 953:5.