One-Stop Hybrid Coronary Revascularization Versus Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention for the Treatment of Multivessel Coronary Artery Disease

Shen, Luhui; Hu, Shengshou; Wang, Haoran; Xiong, Hui; Zheng, Zhe; Li, Lihuan; Xu, Bo; Yan, Hongbing; Gao, Runlin

doi:10.1016/j.jacc.2013.04.007

Cited by 120 publications

(77 citation statements)

References 35 publications

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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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confidence: 99%

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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confidence: 99%

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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“…[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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confidence: 99%

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

et al. 2014

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“…Preliminary studies have shown that a hybrid approach compares favorably with both PCI and traditional CABG. 51,52 If an appropriately designed and powered randomized trial can demonstrate significant benefit with this approach over PCI alone and CABG alone, it may become a preferred approach for many patients and physicians.…”

Section: Will Cabg Utilization Stop Declining?mentioning

confidence: 99%

Coronary Artery Bypass Surgery Is Not Underutilized!

Fearon

Harrington

2016

Circulation

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One-Stop Hybrid Coronary Revascularization Versus Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention for the Treatment of Multivessel Coronary Artery Disease

Abstract: One-stop HCR provides favorable midterm outcomes for selected patients with multivessel coronary artery disease in each risk tertile. For patients with high EuroSCORE or SYNTAX score, it might provide a promising alternative to CABG and PCI.

Cited by 120 publications

References 35 publications

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

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

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

Coronary Artery Bypass Surgery Is Not Underutilized!

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