Hybrid revascularization vs. coronary bypass for coronary artery disease: a systematic review and meta-analysis

Hinojosa-González, David Eugenio; Bueno-Gutierrez, Luis Carlos; Salan-Gomez, Marcelo; Tellez-Garcia, Eduardo; Ramírez-Mulhern, Isabela; Sepulveda-Gonzalez, Diego; Ramonfaur, Diego; Roblesgil‐Medrano, Andres; Flores‐Villalba, Eduardo

doi:10.23736/s0021-9509.22.12163-4

Cited by 2 publications

(4 citation statements)

References 46 publications

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“…Our study findings are remarkable in several ways. In this meta‐analysis, HCR and CABG had comparable rates of mortality and MACCE on both short‐ and long‐term follow up, findings that are in line with the results of previous meta‐analyses such as those by Hinojosa‐Gonzalez et al, Sardar et al, Zhu et al, and Reynolds et al 22,42–44 However, the durability of HCR was challenged with a significantly higher odds of repeat revascularization compared to CABG on long‐term follow‐up. This finding contrasts with a previous meta‐analysis by Sardar et al, 22 that reported similar rates of repeat revascularization between HCR and CABG groups and Van den Eynde et al 45 who reported a significantly lower rate of repeat revascularization in the HCR group compared to the CABG group.…”

Section: Discussionsupporting

confidence: 89%

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Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta‐analysis of 14 studies comprising 4226 patients

Nagraj

Tzoumas

Kakargias

et al. 2022

Cathet Cardio Intervent

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Objectives To compare the outcomes of hybrid coronary revascularization (HCR) with traditional coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD). Background HCR has emerged as an alternative to CABG in patients with MVCAD. Through minimally invasive surgical techniques, HCR carries the potential for faster recovery postoperatively, fewer complications, and lower utilization of resources. Methods Systematic search of electronic databases was conducted up to December 2021 and studies comparing HCR with CABG in the treatment of MVCAD were included in this meta‐analysis. Primary outcomes of interest were incidence of 5‐year mortality and major adverse cardiac and cerebral event (MACCE). Results Fourteen studies (12 observational studies and 2 randomized controlled trials) comprising 4226 patients were included. The rates of 5‐year mortality (odds ratios [OR]: 1.55; 95% confidence interval [CI]: 0.92−2.62; I2 = 83.0%) and long‐term MACCE (OR: 0.97; 95% CI: 0.47−2.01; I2 = 74.7%) were comparable between HCR and CABG groups. HCR was associated with a significantly lower likelihood of perioperative blood transfusion (OR: 0.36; 95% CI: 0.25−0.51; I2 = 55.9%), shorter mean hospital stay (weighted mean difference: −2.04; 95% CI: −2.60 to −1.47; I2 = 54%), and risk of postoperative acute kidney injury (OR: 0.45; 95% CI: 0.23−0.88; p = 0.02). CABG demonstrated a lower likelihood of requiring long‐term repeat revascularization (OR: 1.51; 95% CI: 1.03−2.20; I2 = 18%) over a follow‐up duration of 29.14 ± 21.75 months. Conclusion This meta‐analysis suggests that HCR is feasible and safe for the treatment of MVCAD. However, benefits of HCR should be carefully weighed against the increased long‐term risk of repeat‐revascularization when selecting patients, and further studies evaluating differences in long‐term mortality between HCR and CABG are required.

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Section: Discussionsupporting

confidence: 89%

“…Subgroup analyses were conducted by synthesizing the studies by Ganyokuv et al, 28 Esteves et al, 35 Gasior et al, 37 22,[42][43][44] However, the durability of HCR was challenged with a significantly higher odds of repeat revascularization compared to CABG on long-term follow-up.…”

Section: Sensitivity Analysis Including Only Rctsmentioning

confidence: 99%

Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta‐analysis of 14 studies comprising 4226 patients

Nagraj

Tzoumas

Kakargias

et al. 2022

Cathet Cardio Intervent

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“…A recent review of twenty-two studies with a total of 6,981 individuals shown that HCR is a viable option to standard CABG. Both groups had similar short- and long-term outcomes, including mortality, MACCE, and postoperative morbidity, although hybrid techniques were linked with lower perioperative morbidity ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…Our study population, which included a high proportion of patients who received a reverse hybrid approach, reflects the reality of everyday practice, which is that collaboration between interventional cardiologists and cardiac surgeons needs to improve significantly, and that minimally invasive CABG surgery procedures still account for a small percentage of total CABG surgeries due to limited dissemination. HCR is also not widely used in clinical practice due to a paucity of data in clinical trials involving a great number of individuals with long-term follow-up and diverse HCR operating circumstances ( 30 ), despite the fact that recent meta-analyses on a large number of patients show that HCR achieves good short- and long-term outcomes ( 19 , 20 , 23 , 26 , 30 ). As a result, in many cases, the cardiologist will choose PCI treatment first in order to treat the culprit lesion or the lesion that is most likely to cause the most muscle damage if left untreated.…”

Section: Discussionmentioning

confidence: 99%

Hybrid total arterial minimally invasive off-pump coronary revascularization and percutaneous coronary intervention strategy for multivessel coronary artery disease: a cohort study with a median 11-year follow-up

Rufa,

Ursulescu,

Nagib

et al. 2024

Cardiovasc Diagn Ther

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Background Hybrid coronary revascularization (HCR) is a treatment approach that combines the benefits of coronary artery bypass grafting (CABG) techniques such as minimally invasive direct coronary artery bypass (MIDCAB) or minimally invasive multivessel CABG (MICS-CABG) with percutaneous coronary intervention (PCI) for carefully selected patients with multivessel coronary artery disease (MV CAD). The extant body of research primarily concentrates on the comparison of outcomes between HCR and CABG or PCI. Furthermore, HCR is defined primarily as MIDCAB and PCI. Given the various criteria for HCR identified in the current body of literature, as well as several hybrid revascularization techniques, our primary goal was to analyse the characteristics and track the development of HCR patients operated on in our centre (Robert Bosch Hospital) over both short and long periods of time. Additionally, we sought to validate the practical challenges that arise during the implementation of an HCR methodology. Methods This cohort study included 138 patients with MV CAD who had an HCR approach in conjunction with isolated total arterial off-pump MICS-CABG or MIDCAB between 2007 and 2018 at Robert Bosch Hospital in Stuttgart. Data on major adverse cardiac and cerebral events (MACCE), defined as all-cause mortality, myocardial infarction, repeat revascularization and stroke were gathered through a questionnaire. Long-term follow-up, with a mean duration of 8.7±0.3 years and a median duration of 11 years, was available for a significant majority of the patients (92.8%, n=128). Results The average age was 69.6±11.2 years, with 79% being male. The mean European System for Cardiac Operative Risk Evaluation score I additive (EuroSCORE I) additive was 7.6±10.2 and the mean SYNergy between PCI with TAXUS and Cardiac Surgery (SYNTAX) Score I was 22.9±9.4. A total of 97 MIDCAB surgeries and 41 MICS-CABG procedures were performed without any instances of conversion to sternotomy or cardiopulmonary bypass (CPB). A total of 70 patients, or 50.7% of the sample, received the planned PCI treatment. This percentage was substantially lower in the subgroup with chronic CAD, with just 27, equivalent to 39.1%. The observed 30-day death rate was 2.1% (3/138). During follow-up, 3 myocardial infarctions, 18 PCI repeats, no CABG, and 4 strokes occurred. From 128 followed-up patients, 28 died (21.9%), 7 of which were heart deaths (5.5%). Total MACCE was 36.7%. The survival rates at 3 and 5 years were 92% and 85% respectively. Patients who didn’t get the planned PCI had a mean survival rate of 6.8–9.1 years, while those with completed hybrid treatment had a higher mean survival rate of 8.4–10.2 years. Conclusions In selected individuals with MVCAD, current evidence suggests that HCR is a safe and effective coronary artery revascularization approach. After coronary bypass surgery, the attention going forward needs to be devoted toward the organization o...

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Hybrid revascularization vs. coronary bypass for coronary artery disease: a systematic review and meta-analysis

Cited by 2 publications

References 46 publications

Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta‐analysis of 14 studies comprising 4226 patients

Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta‐analysis of 14 studies comprising 4226 patients

Hybrid total arterial minimally invasive off-pump coronary revascularization and percutaneous coronary intervention strategy for multivessel coronary artery disease: a cohort study with a median 11-year follow-up

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