One-stage hybrid coronary revascularization for the treatment of multivessel coronary artery disease- Periprocedural and long-term results from the "HYBRID-COR" feasibility study

Krzysztof Sanetra; Piotr Paweł Buszman; Justyna Jankowska-Sanetra; Marek Cisowski; Wojciech Fil; Bogdan Gorycki; Andrzej Bochenek; Monika Slabon-Turska; Marta Konopko; Paweł Kaźmierczak; Witold Gerber; Krzysztof Milewski; Paweł Eugeniusz Buszman

doi:10.3389/fcvm.2022.1016255

One-stage hybrid coronary revascularization for the treatment of multivessel coronary artery disease- Periprocedural and long-term results from the "HYBRID-COR" feasibility study

Front Cardiovasc Med. 2022 Oct 19:9:1016255. doi: 10.3389/fcvm.2022.1016255. eCollection 2022.

Authors

Krzysztof Sanetra^{1

2}, Piotr Paweł Buszman^{3

4

5}, Justyna Jankowska-Sanetra⁴, Marek Cisowski⁶, Wojciech Fil^{3

4}, Bogdan Gorycki⁴, Andrzej Bochenek^{2

5

7}, Monika Slabon-Turska⁸, Marta Konopko³, Paweł Kaźmierczak⁹, Witold Gerber^{2

7}, Krzysztof Milewski^{4

5

7}, Paweł Eugeniusz Buszman¹⁰

Affiliations

¹ Clinic of Cardiovascular Surgery, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.
² Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland.
³ Department of Cardiology, Andrzej Frycz Modrzewski Krakow University, Kraków, Poland.
⁴ Department of Cardiology, American Heart of Poland, Bielsko-Biała, Poland.
⁵ Center for Cardiovascular Research and Development, American Heart of Poland, Katowice, Poland.
⁶ Department of Cardiac Surgery, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland.
⁷ Faculty of Medicine, University of Technology, Katowice, Poland.
⁸ Department of Obstetrics and Gynecology, Provincial Specialist Hospital, Wrocław, Poland.
⁹ American Heart of Poland, Katowice, Poland.
¹⁰ Department of Epidemiology, Medical University of Silesia, Katowice, Poland.

Abstract

Background: The constant growth of interest in hybrid coronary artery revascularization (HCR) is apparent. Yet, few studies report outcomes of the one-stage HCR. Consequently, the status of such procedures is not adequately supported in clinical guidelines. The aim of this study was to report the safety, feasibility, and long term-outcomes of the one-stage HCR.

Methods and results: Patients were enrolled in the prospective one-stage hybrid coronary revascularization program (HYBRID-COR). They underwent a one-stage hybrid revascularization procedure while on double antiplatelet therapy (DAPT) with Ticagrelor: endoscopic atraumatic coronary artery bypass grafting (EACAB) for revascularization of the left anterior descending (LAD) artery and percutaneous intervention in non-LAD arteries with contemporary drug-eluting stents. The composite primary endpoint included MACCE (major adverse cardiac and cerebrovascular events: death, myocardial infarction, stroke, and repeated revascularization) in long-term observation. The study cohort consisted of 30 patients (68% male) with stable coronary artery disease (26.7%) and unstable angina (73.3%). Procedural success was 100%. No death, myocardial infarction (MI), or stroke were observed in the perioperative period. One patient (3.3%) required chest revision and blood transfusion due to surgical bleeding. Kidney injury was noted in two patients (6.6%). In a long-term follow-up (median; IQR: 4.25; 2.62-4.69 years), two patients (6.6%) underwent repeated revascularization and one patient (3.3%) died due to MI. The overall primary endpoint rate was 9.9%.

Conclusion: One-stage hybrid revascularization, on DAPT, is a feasible, safe, and efficient way of achieving complete revascularization in selected patients. The complication rate is low and acceptable. Further randomized trials are required.

Keywords: EACAB; coronary artery disease; hybrid; one-stage; revascularization.