Simultaneous Hybrid Revascularization Versus Off-Pump Coronary Artery Bypass for Multivessel Coronary Artery Disease

Hu, Shengshou; Li, Qi; Gao, Peixian; Xiong, Hui; Zheng, Zhe; Li, Lihuan; Xu, Bo; Gao, Runlin

doi:10.1016/j.athoracsur.2010.10.020

Cited by 71 publications

(88 citation statements)

References 26 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.…”

mentioning

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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“…34 -40 Despite the perception that procedural times are longer than for conventional on-pump or off-pump CABG (OPCABG), published data are scanty and inconsistent. Hu et al 33 recently demonstrated that simultaneous (1-stage) HCR performed with the classic MidCAB did not take significantly longer than conventional OPCABG (246Ϯ84 versus 204Ϯ42 minutes, respectively). Furthermore, Kiaii et al 39 reported very impressive procedural times of 205Ϯ39 minutes for simultaneous HCR performed with robotically assisted LIMA harvesting in their series of 58 patients.…”

Section: Justification Of a Surgical Proceduresmentioning

confidence: 99%

“…Although this has, in the past, thwarted broader interest in the hybrid concept, some centers continue to boast excellent results with the classic MidCAB in their integrated approach to HCR. 33 The development of thoracoscopic and robotic techniques for grafting the LIMA to the LAD is certainly more appealing and has led to renewed interest in HCR. These techniques range from endoscopic or robotic harvesting of the LIMA with manual construction of the LAD anastomosis to a completely endoscopic approach performed on a beating heart.…”

Section: Justification Of a Surgical Proceduresmentioning

confidence: 99%

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

2012

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“…Since then, some methodological changes have been made, such as off-pump surgery, 2 hybrid revascularization (CABG and percutaneous coronary intervention), 3,4 and minimally invasive direct coronary artery bypass, trying to make this procedure less aggressive or invasive, although the regular CABG performed nowadays usually still requires sternotomy and sometimes saphenectomy, because the saphenous veins are additional or alternative bypass conduits to the left and right mammary or radial arteries, the first choice because of longer patency.…”

Section: There Is No Role For Cardiac Rehabilitation After Coronary Amentioning

confidence: 99%

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting?

Mendes

2016

Circulation

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Simultaneous Hybrid Revascularization Versus Off-Pump Coronary Artery Bypass for Multivessel Coronary Artery Disease

Cited by 71 publications

References 26 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?

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

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting?

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