Hybrid Procedures Have Proven Clinical Utility and Are the Wave of the Future

Shannon, Joanne; Colombo, Antonio; Alfieri, Ottavio

doi:10.1161/circulationaha.111.041186

Cited by 19 publications

(4 citation statements)

References 68 publications

(53 reference statements)

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“…Replacing full median sternotomy with right minithoracotomy for aortic valve surgery should result in reduction of surgical perioperative trauma, preserved stability of the thorax, and improved respiratory function in the early postoperative period [ 16 ]. There are still problematic issues connected with the hybrid treatment of cardiac disease; these are the sequence of both components, the duration of the interval between procedures, and antiplatelet therapy [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…The intention to perform less invasive RT-AVR/PCI instead of AVR/CABG is because RT-AVR/PCI is a lower-risk procedure compared with AVR/CABG [ 14 , 15 ]. This procedure is even more reasonable for elderly, higher-risk patients with comorbidities, as our results confirm.…”

Section: Discussionmentioning

confidence: 99%

“…The aim of this approach is to reduce surgical invasiveness with the implementation of less invasive cardiac surgery procedures instead of the conventional full sternotomy technique [10][11][12]. It has already been suggested that avoiding conventional CABG and replacing it with modern percutaneous techniques offers the opportunity to expand the indications for minimally invasive valve surgery to patients with concomitant coronary disease [13][14][15]. Replacing full median sternotomy with right minithoracotomy for aortic valve surgery should result in reduction of surgical perioperative trauma, preserved stability of the thorax, and improved respiratory function in the early postoperative period [16].…”

Section: Discussionmentioning

confidence: 99%

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Patients with aortic valve disease and coronary artery disease can benefit from a hybrid approach combining aortic valve replacement through right minithoracotomy and percutaneous coronary intervention

Rzucidło-Resil,

Stoliński,

Musiał

et al. 2023

kitp

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Introduction Minimally invasive and hybrid procedures for patients with aortic valve pathology and coronary artery disease are innovative solutions. Aim To report the results of hybrid aortic valve replacement through right anterior minithoracotomy (RT-AVR)/percutaneous coronary intervention (PCI) and conventional aortic valve replacement (AVR)/coronary artery bypass grafting (CABG) surgery for patients with aortic valve and coronary artery disease. Material and methods Analysis of prospectively gathered data of 187 patients – 86 hybrid and 101 conventional procedures. For 21 patients, RT-AVR was followed by PCI during the same session, and for 65 patients RT-AVR was performed within 90 days of PCI. Results Hospital mortality in the AVR/CABG and RT-AVR/PCI groups was 3.0% and 1.2%, respectively ( p = 0.237). Complications occurred in 18.6% of patients in the RT-AVR/PCI group and 33.7% in the AVR/CABG group ( p = 0.020). Two-stage RT-AVR/PCI was performed due to ACS (100%); one-stage was due to the intention to perform a minimally invasive procedure instead of AVR/CABG (71.4%) or due to replacing CABG with PCI because of a lack of vascular grafts for CABG (19.1%). In 38.5% of patients from the two-stage subgroup, antiplatelet therapy was stopped before RT-AVR, 32.3% of patients from the two-stage subgroup were on single, and 29.2% on dual antiplatelet therapy until RT-AVR, which had no influence on postoperative blood requirements or postoperative myocardial infarction ( p = 0.410 and p = 0.077, respectively). Conclusions The hybrid procedure presented in our series showed similar mortality and morbidity results and may be an alternative to conventional AVR and CABG through full sternotomy in selected patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Patients with aortic valve disease and coronary artery disease can benefit from a hybrid approach combining aortic valve replacement through right minithoracotomy and percutaneous coronary intervention

Rzucidło-Resil,

Stoliński,

Musiał

et al. 2023

kitp

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“…In recent years, several institutional series have confirmed that HCR can be accomplished safely with low operative mortality (<2%) and low morbidity. 7 Thus, is HCR the future in coronary revascularization? The results from the practice patterns in the United States described by Harskamp et al 5 warrant caution.…”

Section: Article See P 872mentioning

confidence: 99%

Hybrid Coronary Revascularization

Gošev

Leacche

2014

Circulation

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A dvancement in technique and technology over the past 2 decades has helped improve clinical outcomes in both surgical and interventional percutaneous coronary revascularization. Hybrid coronary revascularization (HCR) procedures introduced in 2011 by the American Heart Association/ American College of Cardiology Foundation updated guidelines for coronary artery bypass grafting (CABG) surgery, 1 combine the superiority of the left internal mammary artery (LIMA) to the left anterior descending artery (LAD) revascularization 2,3 with percutaneous coronary intervention (PCI) by means of drug-eluting stents (DES) for non-LAD vessels. 4Various minimally invasive surgical approaches are used to perform the LIMA to LAD graft. These approaches and techniques include off-pump coronary revascularization, robotically assisted procedures, small left thoracotomy, and partial sternotomy. Article see p 872In the current issue of Circulation, Harskamp and colleagues 5 describe contemporary practice patterns and clinical outcomes after hybrid coronary artery revascularization in the United States. Isolated CABG in patients who underwent HCR in the Society of Thoracic Surgeons Adult Database between July 2011 and March 2013 were the subject of the study. The authors found only 0.48% (n=950) of 198 622 CABG patients had HCR with 809 of 950 patients (85%) having a staged procedure, whereas a small number of patients (141 of 950; 15%) had HCR done concurrently. Only one third of the centers performing CABG procedures participated in the HCR cohort.Patients with HCR had higher cardiovascular risk profiles than CABG patients, whereas CABG patients had more complex coronary anatomy. HCR patients had more off-pump procedures performed and more nonsternotomy approaches. HCR patients also had a higher incidence of robotic assistance. Overall, outcomes were similar between the groups for the composite of in-hospital mortality and major morbidity.The concept of HCR was introduced by Angelini and colleagues 6 in 1996 by performing a minimally invasive thoracotomy LIMA-LAD anastomosis and balloon angioplasty of the non-LAD vessels. Since then, implementation of this procedure has been limited because of the complexity and learning curve of the surgical techniques and suboptimal results of bare-metal stenting compared with surgical revascularization. With the introduction of DES and the decreased rate of stent restenosis, HCR has reemerged as an alternative to conventional surgical revascularization in high-risk patients. In recent years, several institutional series have confirmed that HCR can be accomplished safely with low operative mortality (<2%) and low morbidity. Thus, is HCR the future in coronary revascularization? The results from the practice patterns in the United States described by Harskamp et al 5 warrant caution. The learning curve, the financial and time commitment, and the need for a hybrid operating room create stringent requirements that many programs will not be able to support. In addition, the clinical benefit of HCR ove...

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