One-Stop Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease

Dongjie Li; Yulin Guo; Yingdi Gao; Xiangguang An; Yan Liu; Song Gu; Xitao Zhang; Jiuchang Zhong; Jie Gao; Pixiong Su

doi:10.3389/fcvm.2021.755797

One-Stop Hybrid Coronary Revascularization Versus Off-Pump Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease

Front Cardiovasc Med. 2021 Dec 17:8:755797. doi: 10.3389/fcvm.2021.755797. eCollection 2021.

Authors

Dongjie Li¹, Yulin Guo¹, Yingdi Gao¹, Xiangguang An¹, Yan Liu¹, Song Gu¹, Xitao Zhang¹, Jiuchang Zhong², Jie Gao¹, Pixiong Su¹

Affiliations

¹ Department of Cardiac Surgery, Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
² Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.

Abstract

Background: Data on one-stop hybrid coronary revascularization (HCR) are limited. This study aimed to compare the early and midterm outcomes of one-stop HCR with off-pump coronary artery bypass grafting (OPCAB) in patients with multivessel coronary artery disease. Methods: From April 2018 to May 2021, 752 patients with multivessel coronary artery disease who underwent isolated one-stop HCR or OPCAB were retrospectively included in this analysis. After exclusion and propensity score matching, 151 patients who underwent HCR were matched with 151 patients who underwent OPCAB. The primary endpoints were midterm major adverse cardiovascular and cerebrovascular events (MACCE) after the procedure. The secondary endpoints were in-hospital complications and outcomes. Results: The preprocedural characteristics were well balanced between the two groups after matching. The HCR group was associated with a lower rate of perioperative transfusion (23.8 vs. 53.0%, p < 0.001) and new-onset atrial fibrillation (AF) (5.3 vs. 15.2%, p = 0.004), shorter time of mechanical ventilation (h) [15 (16, 17) vs. 17 (16, 20), p < 0.001], and shorter length of stay (LOS) in the hospital (days) [19 (16, 24) vs. 22 (18, 27), p = 0.001]. Cumulated MACCE rates were similar between the two groups (15.9 vs. 14.0%, p = 0.59) during a median follow-up of 20 months. Conclusions: One-stop HCR is safe and efficacious with less invasiveness and faster postoperative recovery in selected patients with multivessel coronary artery disease. Randomized controlled trials with larger sample sizes and long-term follow-up are warranted to confirm these findings.

Keywords: hybrid coronary revascularization (HCR); major adverse cardiovascular and cerebrovascular events (MACCE); minimally invasive direct coronary artery bypass (MIDCAB); off-pump coronary artery bypass graft (OPCAB); percutaneous coronary intervention (PCI).