Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting for the Treatment of Multivessel Coronary Artery Disease

Halkos, Michael E.; Vassiliades, Thomas A.; Douglas, John S.; Morris, Douglas C.; Rab, S. Tanveer; Liberman, Henry; Samady, Habib; Kilgo, Patrick D.; Guyton, Robert A.; Puskas, John D.

doi:10.1016/j.athoracsur.2011.05.090

Cited by 105 publications

(83 citation statements)

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“…[1][2][3] In most cases, HCR involves a surgical procedure in which the internal mammary artery (IMA) is grafted to the left anterior descending (LAD) coronary artery, preceded or followed by percutaneous coronary intervention (PCI) of non-LAD coronary lesions, either performed in 1 setting (concurrent) or as a staged procedure. 4 A prerequisite for HCR is that the patient has LAD anatomy that is eligible for surgical revascularization, but also has non-LAD lesions that are amenable for PCI.…”

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Practice Patterns and Clinical Outcomes After Hybrid Coronary Revascularization in the United States

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Practice Patterns and Clinical Outcomes After Hybrid Coronary Revascularization in the United States

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“…20 The reported stroke rates were 0% to 1.7%. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] It is notable that despite the anaortic approach used for the HCR CABG arm (mostly in situ LIMA conduit), the stroke rates are not much lower.There are two meta-analyses that evaluate the studies done on HCR and conventional CABG patients (Table 2). 27,28 Phan and Harskamp both showed that there is no benefit for perioperative mortality, stroke, or 1-year freedom from major adverse events when using HCR over CABG.…”

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Minimally Invasive Multivessel Coronary Surgery and Hybrid Coronary Revascularization: Can We Routinely Achieve Less Invasive Coronary Surgery?

Rodriguez

Ruel

2016

Methodist DeBakey Cardiovascular Journal

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Editor's Note: We are pleased to offer 1 credit of Continuing Medical Education for successfully completing an online quiz about this article. You may access the quiz at www.houstonmethodist.org/cme-online. AbstractCoronary artery bypass grafting (CABG) is the gold standard in managing severe coronary artery disease. However, it is associated with prolonged recovery and potential complications, in part due to the invasiveness of the procedure. Less invasive CABG techniques attempt to improve the quality and quantity of life in the same way as surgical revascularization but with fewer complications.Minimally invasive coronary surgery (MICS) through a small thoracotomy allows for complete revascularization with good results in graft patency. Perioperative mortality is low, and there is decreased need for blood transfusion, lower surgical site infection rates, and an earlier return to full physical function. Hybrid coronary revascularization (HCR) attempts to combine the advantages of coronary artery bypass grafting with those of percutaneous coronary intervention. Several studies have shown that HCR provides better short-term outcomes with regard to decreased ventilation and ICU time, reduced need for blood transfusion, and shortened hospital stay. However, the rates for major adverse cardiovascular events and mortality are comparable to conventional CABG, except for patients with a high SYNTAX score who displayed increased mortality rates. There is also strong evidence of a higher need for repeat revascularization with HCR compared to CABG.Overall, MICS and HCR appear to be viable alternatives to conventional CABG, offering a less invasive approach to coronary revascularization, which may be especially beneficial to high-risk patients. This article discusses approaches that deliver the advantages of minimally invasive surgical revascularization that can be adapted by surgeons with minimal investment with regards to training and infrastructure.MDCVJ | XII (1) 2016 15 houstonmethodist.org/debakey-journal With MICS-CABG, complete myocardial revascularization is achievable in more than 95% of cases 1 since the technique allows access to the anterior, lateral, and inferior walls of the heart with or without use of CPB. Perioperative mortality is low at 1.3%. 1Other advantages include a decreased need for blood transfusion, lower surgical site infection rates, and earlier return to full physical function.1,3,4 Associated complications include sternotomy conversion and development of left-sided pleural effusion. 1,3,5 Postoperative pain can be an issue during the initial hours, but it is transient, controllable, and significantly reduced by the third postoperative day; it is also associated with an overall improved postoperative pain picture with improved pulmonary functions. 6,7 Notably, unlike sternotomy patients, MICS-CABG patients have no physical restriction postoperatively, which leads to improved independence. Even though MICS-CABG is more technically demanding, its anastomotic patency results were validated to...

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“…Na maioria dos registros de RMH encontrados na literatura, nos quais a técnica inicialmente utilizada foi a da CRM, (133)(134)(135) a cirurgia foi realizada apenas sob o efeito de aspirina. O medicamento clopidogrel só era iniciado após pelo menos 4h do fim da CRM, quando já era mínimo o risco de complicações hemorrágicas desencadeadas pela utilização da DAP.…”

Section: Terapia De Antiagregação Plaquetáriaunclassified

“…Nos casos em que a ICP é realizada primeiramente, a DAP é iniciada antes do procedimento hemodinâmico e mantida durante a realização da CRM. (134) Quando a RMH é realizada de maneira simultânea, a CRM é realizada apenas sob o uso de heparina e ao final da anastomose ATI -IVA ou imediatamente antes da ICP, é realizada uma dose de ataque de clopidogrel, através de uma sonda naso-gástrica, de 300 a 600 mg. (129,(136)(137)(138)(139) Uma outra alternativa seria uma dose inical de clopidogrel durante a indução anestésica, (135) já que o pico de inibição plaquetária do clopidogrel ocorre entre 4 e 24 horas após sua administração, permitindo que a RMH simultânea seja realizada com maior segurança. (140,141) Muito ainda precisa ser discutido em relação à melhor forma de realizar a DAP na RMH, precisaremos aguardar por melhores evidências na literatura, como grandes estudos prospectivos e randomizados.…”

Section: Terapia De Antiagregação Plaquetáriaunclassified

“…A RMH mostrou ter uma menor morbidade às custas de menores taxas de transfusão sanguínea, (131,134,136) menor tempo de internação em unidades de terapia intensiva (UTI), menores tempos de internação hospitalar e recuperação pós-operatória mais rápida. (129,130,142,149) Nos pacientes submetidos a RMH, excelentes taxas de patência do enxerto de ATI -DA têm sido relatadas.…”

Section: Terapia De Antiagregação Plaquetáriaunclassified

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Revascularização miocárdica híbrida versus cirúrgica em pacientes com doença aterosclerótica coronária multiarterial: estudo clínico prospectivo randomizado

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Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting for the Treatment of Multivessel Coronary Artery Disease

Cited by 105 publications

References 25 publications

Practice Patterns and Clinical Outcomes After Hybrid Coronary Revascularization in the United States

Practice Patterns and Clinical Outcomes After Hybrid Coronary Revascularization in the United States

Minimally Invasive Multivessel Coronary Surgery and Hybrid Coronary Revascularization: Can We Routinely Achieve Less Invasive Coronary Surgery?

Revascularização miocárdica híbrida versus cirúrgica em pacientes com doença aterosclerótica coronária multiarterial: estudo clínico prospectivo randomizado

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