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Torre T, Pozzoli A, Valgimigli M, Leo LA, Toto F, Muretti M, Birova S, Ferrari E, Pedrazzini G, Demertzis S. Minimally Invasive Isolated and Hybrid Surgical Revascularization for Multivessel Coronary Disease: A Single-Center Long-Term Follow-Up. J Pers Med 2024; 14:528. [PMID: 38793110 PMCID: PMC11122097 DOI: 10.3390/jpm14050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/09/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Some evidence suggests that surgical minimally invasive (MIDCAB) and hybrid coronary revascularization (HCR) are safe and potentially effective at short-term follow-up. Data on long-term outcomes are more limited and inconclusive. METHODS Between February 2013 and December 2023, a total of 1997 patients underwent surgical coronary artery revascularization at our institution, of whom, 92 (4.7%) received left anterior mini-thoracotomy access (MIDCAB), either isolated (N = 78) or in combination with percutaneous coronary intervention (N = 14, HCR group). RESULTS After a median follow-up of 75 months (range 3.1: 149 months), cardiac mortality was 0% while overall mortality was 3%, with one in-hospital mortality and two additional late deaths. Conversion to sternotomy happened in two patients (2.1%), and surgical re-explorations occurred in five patients (4.6%), of whom three for bleeding and two for graft failure. All patients received left internal mammary (LIMA) to left anterior descending artery (LAD) grafting (100%). In the HCR group, 10 patients (72%) showed percutaneous revascularization (PCI) after MIDCAB, showing PCI on a mean of 1.6 ± 0.6 vessels and implanting 2.1 ± 0.9 drug-eluting stents. CONCLUSIONS MIDCAB, in isolation or in association with hybrid coronary revascularization, is associated with encouraging short- and long-term results in selected patients discussed within a dedicated heart-team.
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Affiliation(s)
- Tiziano Torre
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Alberto Pozzoli
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Marco Valgimigli
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Laura Anna Leo
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
| | - Francesca Toto
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Mirko Muretti
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Sara Birova
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
| | - Enrico Ferrari
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Medicine, University of Zurich (UZH), 8032 Zurich, Switzerland
| | - Giovanni Pedrazzini
- Cardiology Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland (L.A.L.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Stefanos Demertzis
- Heart Surgery Unit, Cardiocentro Ticino Institute, EOC, 6900 Lugano, Switzerland; (T.T.); (F.T.); (M.M.); (S.B.); (E.F.); (S.D.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
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Shimamura J, Miyamoto Y, Hibino M, Fukuhara S, Takayama H, Itagaki S, Takagi H, Kuno T. Long-Term Outcomes After Hybrid Coronary Revascularization Versus Coronary Artery Bypass Grafting: Meta-Analysis of Kaplan-Meier-Derived Data. Am J Cardiol 2024; 212:13-22. [PMID: 38008347 DOI: 10.1016/j.amjcard.2023.11.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 11/28/2023]
Abstract
Hybrid coronary revascularization (HCR) is an alternative option to conventional coronary artery bypass grafting (CABG), but the long-term outcomes of HCR versus CABG remain unclear. We aimed to analyze the long-term outcomes after HCR and CABG for patients with multivessel coronary artery disease using meta-analysis. A systemic literature search of PubMed and EMBASE was performed from inception to March 2023. Studies reporting Kaplan-Meier curves with follow-up ≥1 year were included. The primary outcome was all-cause mortality, and the secondary outcomes were major adverse cardiac and cerebrovascular events (MACCEs) and repeat revascularization. In total, 13 studies (1 randomized controlled trial and 12 propensity-score matched observational studies) were analyzed. The mean follow-up period was 5.1 ± 3.1 years. HCR was associated with similar overall mortality (hazard ratio [HR] 1.09, 95% confidence interval [CI] 0.87 to 1.36), significantly higher incidence of MACCEs (HR 1.49, 95% CI 1.07 to 2.06), and repeat revascularization (HR 2.01, 95% CI 1.53 to 2.64) compared with CABG. In phase-specific analysis, the mortality rate was similar, and the incidence of repeat revascularization was higher in HCR regardless of phases. The incidence of MACCEs was higher in HCR during the mid-term phase (1 to 5 years), but it was similar during the long-term phase (long-term: ≥5 years). In conclusion, despite the higher incidence of MACCEs and repeat revascularization compared with CABG, HCR offered a similar long-term survival. Even longer-term follow-up and randomized controlled trials with a large population are warranted to investigate the role of HCR for multivessel coronary artery disease.
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Affiliation(s)
- Junichi Shimamura
- Division of Cardiothoracic Surgery, Westchester Medical Center, Valhalla, New York
| | - Yoshihisa Miyamoto
- Division of Nephrology and Endocrinology, University of Tokyo, Tokyo, Japan
| | - Makoto Hibino
- Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia
| | - Shinichi Fukuhara
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan
| | - Hiroo Takayama
- Division of Cardiothoracic Surgery, Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York
| | - Shinobu Itagaki
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center, Albert Einstein Medical College, Bronx, New York; Division of Cardiology, Jacobi Medical Center, Albert Einstein Medical College, Bronx, New York.
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Purmessur R, Wijesena T, Ali J. Minimal-Access Coronary Revascularization: Past, Present, and Future. J Cardiovasc Dev Dis 2023; 10:326. [PMID: 37623339 PMCID: PMC10455416 DOI: 10.3390/jcdd10080326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/16/2023] [Accepted: 07/22/2023] [Indexed: 08/26/2023] Open
Abstract
Minimal-access cardiac surgery appears to be the future. It is increasingly desired by cardiologists and demanded by patients who perceive superiority. Minimal-access coronary artery revascularisation has been increasingly adopted throughout the world. Here, we review the history of minimal-access coronary revascularization and see that it is almost as old as the history of cardiac surgery. Modern minimal-access coronary revascularization takes a variety of forms-namely minimal-access direct coronary artery bypass grafting (MIDCAB), hybrid coronary revascularisation (HCR), and totally endoscopic coronary artery bypass grafting (TECAB). It is noteworthy that there is significant variation in the nomenclature and approaches for minimal-access coronary surgery, and this truly presents a challenge for comparing the different methods. However, these approaches are increasing in frequency, and proponents demonstrate clear advantages for their patients. The challenge that remains, as for all areas of surgery, is demonstrating the superiority of these techniques over tried and tested open techniques, which is very difficult. There is a paucity of randomised controlled trials to help answer this question, and the future of minimal-access coronary revascularisation, to some extent, is dependent on such trials. Thankfully, some are underway, and the results are eagerly anticipated.
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Affiliation(s)
- Rushmi Purmessur
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK
| | - Tharushi Wijesena
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK
| | - Jason Ali
- Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge CB2 0AY, UK
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