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Willard R, Scheinerman J, Pupovac S, Patel NC. The Current State of Hybrid Coronary Revascularization. Ann Thorac Surg 2024; 118:318-328. [PMID: 38677447 DOI: 10.1016/j.athoracsur.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/15/2024] [Accepted: 04/04/2024] [Indexed: 04/29/2024]
Abstract
Hybrid coronary revascularization (HCR) combines a minimally invasive surgical approach with percutaneous coronary intervention (PCI) for the treatment of multivessel coronary artery disease. Despite decades of use, widespread acceptance has been limited. In this review, we conduct a comparative assessment of HCR in relation to traditional coronary artery bypass graft surgery and multivessel PCI. Although large-scale randomized data are still lacking, numerous studies have demonstrated that HCR may offer benefits regarding resource utilization and short-term morbidity while delivering comparable mid- and long-term survival compared with traditional bypass surgery. Compared with PCI, HCR may offer similar periprocedural morbidity while mitigating the need for repeat revascularization by providing a surgical arterial bypass graft to the left anterior descending artery.
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Affiliation(s)
- Robin Willard
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York
| | - Joshua Scheinerman
- Department of Cardiothoracic Surgery, New York University Grossman School of Medicine, New York, New York
| | - Stevan Pupovac
- Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital/Northwell Health, New York, New York
| | - Nirav C Patel
- Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York.
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Hasan SU, Pervez A, Naseeb MW, Rajput BS, Faheem A, Hameed I, Sá MP, Zubair MM. Clinical outcomes of different revascularization approaches for patients with multi-vessel coronary artery disease: A network meta-analysis. Perfusion 2023:2676591231182585. [PMID: 37294619 DOI: 10.1177/02676591231182585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND As surgical techniques continue to evolve, the optimal approach for revascularizing multi-vessel coronary artery disease (CAD) remains a matter of ongoing debate. Accordingly, our objective was to compare and contrast various surgical techniques utilized in the management of multi-vessel CAD. METHODS A systematic literature review was performed using PubMed, Embase, and Cochrane central register of controlled trials from inception to May 2022. Random-effects network meta-analysis was performed for the primary outcome; target vessel revascularization (TVR), and secondary outcomes; mortality, major adverse cardiac and cerebrovascular events, postoperative myocardial infarction, new-onset atrial fibrillation, stroke, new-onset dialysis, in patients undergoing percutaneous coronary intervention (PCI) with a stent, off-pump coronary bypass graft, on-pump coronary artery bypass graft (ONCABG), hybrid coronary revascularization, minimally-invasive coronary artery bypass, or robot-assisted coronary artery bypass (RCAB) surgeries. RESULTS A total of 8841 patients were included from 23 studies. The analysis showed that ONCABG had the highest freedom from TVR, with a mean (SD) absolute risk of 0.027 (0.029); although ONCABG was found to be superior to all other methods, it was only significantly better than first-generation stent PCI. While RCAB did not demonstrate significant superiority over other treatments, it showed a greater probability of preventing postoperative complications. Notably, no significant heterogeneity was calculated for any of the reported outcomes. CONCLUSIONS ONCABG shows a better rank probability compared to all other techniques for preventing TVR, while RCAB offers greater freedom from most postoperative complications. However, given the absence of randomized controlled trials, these results should be interpreted with caution.
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Affiliation(s)
| | | | | | | | - Ariba Faheem
- Dow University of Health Sciences, Karachi, Pakistan
| | - Irbaz Hameed
- Department of Cardiothoracic Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Michel Pompeu Sá
- Department of Cardiac Surgery, Lankenau Heart Institute, Wynnewood, PA, USA
| | - M Mujeeb Zubair
- Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Hinojosa-Gonzalez DE, Bueno-Gutierrez LC, Salan-Gomez M, Tellez-Garcia E, Ramirez-Mulhern I, Sepulveda-Gonzalez D, Ramonfaur D, Roblesgil-Medrano A, Flores-Villalba E. Hybrid revascularization vs. coronary bypass for coronary artery disease: a systematic review and meta-analysis. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:353-368. [PMID: 35343660 DOI: 10.23736/s0021-9509.22.12163-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Coronary artery bypass graft is the mainstay of treatment for multivessel coronary artery disease and is superior to percutaneous coronary intervention. Combined approaches such as hybrid coronary revascularization integrate coronary artery bypass grafting with percutaneous coronary intervention during the same procedure or weeks apart. These attempt to improve surgical morbidity and long-term outcomes. EVIDENCE ACQUISITION Per PRISMA criteria, a systematic review of keywords "Hybrid Revascularization," "Hybrid Coronary Revascularization," "Surgical," "Surgery," "Treatment," "CABG," "HCR" and "PCI" was conducted in PubMed, EMBASE and SCOPUS. Studies comparing this technique's performance on either single or two-stage approach against traditional multiple vessel coronary artery bypass grafting were screened and analyzed for our review. EVIDENCE SYNTHESIS Twenty-two studies totaling 6981 participants were ultimately included for analysis. Mean differences in operative time, bleeding, ventilator time and length of stay were significantly lower in the hybrid coronary revascularization group. Odds ratios in transfusions and in-hospital myocardial infarction were also lower in the hybrid coronary revascularization group. Results for in-hospital and all-cause mortality, major adverse cardiac events (MACE), stroke, reintervention, and complete revascularization were not significantly different. CONCLUSIONS Our analysis shows hybrid coronary revascularization is a feasible alternative to traditional coronary artery bypass grafting. Short-and long-term outcomes including mortality, MACE, and postoperative morbidity are similar between both groups, while hybrid approaches are associated with decreased perioperative morbidity.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eduardo Flores-Villalba
- School of Medicine and Health Sciences TecSalud ITESM, Monterrey, Mexico -
- School of Engineering and Sciences TecSalud ITESM, Monterrey, Mexico
- Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Monterrey, Mexico
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Narayan P, Angelini GD. Robotically assisted hybrid coronary revascularization—Masterly technique but is it for the masses? J Card Surg 2022; 37:906-908. [PMID: 35060206 PMCID: PMC9303741 DOI: 10.1111/jocs.16241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Pradeep Narayan
- Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health Kolkata West Bengal India
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Narayan P, Angelini GD. Robotic hybrid coronary revascularization-A need for strategy specific data. J Card Surg 2021; 37:512-514. [PMID: 34811820 DOI: 10.1111/jocs.16150] [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: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/27/2022]
Abstract
Robotic totally endoscopic techniques to perform the left internal thoracic artery to left anterior descending graft, coupled with percutaneous coronary intervention (PCI), provide the least invasive option to achieve hybrid coronary revascularization (HCR). Shorter hospital stays and reduced need for blood transfusions have been consistently being reported by several studies along with similar long-term outcomes. Considerable variations exist in the definition of HCR which can be single or two-staged with surgical revascularization being carried out after PCI or vice versa. Variations also exist with respect to usage of cardiopulmonary bypass, surgical incisions, and the use of minimally invasive robotic techniques. The different strategies of HCR do not lead to similar outcomes and the findings of one strategy cannot be extrapolated to the entire group. Studies reporting different strategies of HCR should ideally provide more granular data when reporting outcomes.
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Affiliation(s)
- Pradeep Narayan
- Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
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6
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Affiliation(s)
- Pradeep Narayan
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, India
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Abstract
Combined surgical and percutaneous coronary revascularization, ie, hybrid coronary revascularization (HCR) consists of surgical left internal mammary artery (LIMA) bypass to the left anterior descending artery (LAD) and percutaneous revascularization of other diseased coronary arteries. Developed as a 1-stage procedure, HCR has not been widely adopted by the cardiovascular community. The recommended minimally invasive approach through a small left thoracotomy incision is technically demanding, and same-day percutaneous revascularization requires a hybrid operating room that is not available in most hospitals. In this review, we consider present HCR protocols, barriers to widespread adoption of HCR, and we give special attention to the surgical approach for the LIMA graft to the LAD and the timing of percutaneous revascularization. We conclude that grafting the LIMA to the LAD through a median sternotomy approach and delaying the percutaneous revascularization may facilitate the widespread use of HCR in patients with multivessel coronary artery disease and a low to intermediate Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery score.
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Fatehi Hassanabad A, Kang J, Maitland A, Adams C, Kent WDT. Review of Contemporary Techniques for Minimally Invasive Coronary Revascularization. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:231-243. [PMID: 34081874 PMCID: PMC8217892 DOI: 10.1177/15569845211010767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/17/2022]
Abstract
Minimally invasive coronary revascularization techniques aim to avoid median sternotomy with its associated complications, while facilitating recovery and maintaining the benefits of surgical revascularization. The 3 most common procedures are minimally invasive coronary artery bypass grafting, totally endoscopic coronary artery bypass, and hybrid coronary revascularization. For a variety of reasons, including cost and technical difficulty, not many centers are routinely performing minimally invasive coronary revascularization. Nevertheless, many studies have assessed the safety and efficacy of each of these procedures in different clinical contexts. Thus far results have been promising, and with the evolution of procedural techniques, these approaches have the potential to redefine coronary revascularization in the future. This review highlights the current state of minimally invasive coronary revascularization techniques by exploring their benefits, identifying barriers to their adoption, and discussing future potential paradigms.
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Affiliation(s)
- Ali Fatehi Hassanabad
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - Jimmy Kang
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Andrew Maitland
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - Corey Adams
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
| | - William D. T. Kent
- Section of Cardiac Surgery, Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Canada
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Revascularización coronaria quirúrgica mínimamente invasiva (MIDCAB). CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Moreno PR, Stone GW, Gonzalez-Lengua CA, Puskas JD. The Hybrid Coronary Approach for Optimal Revascularization. J Am Coll Cardiol 2020; 76:321-333. [DOI: 10.1016/j.jacc.2020.04.078] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
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Leyvi G, Dabas A, Leff JD. Hybrid Coronary Revascularization - Current State of the Art. J Cardiothorac Vasc Anesth 2019; 33:3437-3445. [DOI: 10.1053/j.jvca.2019.08.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/21/2019] [Accepted: 08/26/2019] [Indexed: 11/11/2022]
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Moll V, Maffeo C, Mitchell M, Ward CT, Groff RF, Lee SC, Halkos ME, Jabaley CS, O’Reilly-Shah VN. Association of Serratus Anterior Plane Block for Minimally Invasive Direct Coronary Artery Bypass Surgery With Higher Opioid Consumption: A Retrospective Observational Study. J Cardiothorac Vasc Anesth 2018; 32:2570-2577. [DOI: 10.1053/j.jvca.2018.04.043] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Indexed: 11/11/2022]
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Gaudino M, Bakaeen F, Davierwala P, Di Franco A, Fremes SE, Patel N, Puskas JD, Ruel M, Torregrossa G, Vallely M, Taggart DP. New Strategies for Surgical Myocardial Revascularization. Circulation 2018; 138:2160-2168. [DOI: 10.1161/circulationaha.118.035956] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mario Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York City, NY (M.G., A.D.F.)
| | - Faisal Bakaeen
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, OH (F.B.)
| | | | - Antonino Di Franco
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York City, NY (M.G., A.D.F.)
| | - Stephen E. Fremes
- Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Ontario, Canada (S.E.F.)
| | - Nirav Patel
- Lenox Hill Hospital, New York City, NY (N.P.)
| | - John D. Puskas
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY (J.D.P., G.T.)
| | - Marc Ruel
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ontario, Canada (M.R.)
| | - Gianluca Torregrossa
- Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, New York City, NY (J.D.P., G.T.)
| | - Michael Vallely
- Sydney Medical School, University of Sydney, Australia (M.V.)
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Saha T, Naqvi S, Goldberg S. Hybrid Revascularization: A Review. Cardiology 2018; 140:35-44. [DOI: 10.1159/000488190] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 03/05/2018] [Indexed: 11/19/2022]
Abstract
Hybrid coronary revascularization (HCR) combines surgical bypass with percutaneous coronary intervention (PCI) performed either during the same procedure or in a staged approach within 60 days. Coronary artery bypass grafting using the left internal mammary artery (LIMA) has shown excellent long-term patency with improved patient survival. It remains the gold standard treatment for the majority of patients with multivessel coronary artery disease. However, saphenous vein grafts have poor long-term patency. Advances in stent technology have resulted in reduced rates of thrombosis and restenosis, making PCI a viable alternative to coronary surgery in selected patients. HCR is attractive as a less invasive method of coronary revascularization which preserves the benefits of the LIMA performed with less invasive surgical techniques with the efficacy of newer generation stents.
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15
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Leyvi G, Vivek K, Sehgal S, Warrick A, Moncada KA, Shilian N, Leff JD, Michler RE, DeRose JJ. A Comparison of Inflammatory Responses Between Robotically Enhanced Coronary Artery Bypass Grafting and Conventional Coronary Artery Bypass Grafting: Implications for Hybrid Revascularization. J Cardiothorac Vasc Anesth 2017; 32:251-258. [PMID: 28807577 DOI: 10.1053/j.jvca.2017.04.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The inflammatory response elicited by robotically enhanced coronary artery bypass grafting (r-CABG) has not been well described. When r-CABG is performed as part of hybrid coronary revascularization, the inflammatory milieu and the timing of percutaneous coronary intervention may affect the stent patency negatively in the short and long term. The goal of this study was to describe the extent and time course of cytokine release after r-CABG compared with conventional CABG (c-CABG) and to elucidate the optimal timing for r-CABG in the setting of hybrid coronary revascularization for a future study. DESIGN Prospective, observational study. SETTING Tertiary-care center in a university hospital. PARTICIPANTS The study comprised patients scheduled to undergo r-CABG or c-CABG from October 2012 to November 2014. INTERVENTIONS Cytokine levels of interleukin (IL)-6, IL-8, IL-10; tumor necrosis factor-α; and C-reactive protein (CRP) were measured at the following time points: preprocedure; at the end of the procedure; and at 4, 8, 12, 24, and 48 hours after the procedure. MEASUREMENTS AND MAIN RESULTS Twenty-eight patients undergoing r-CABG and 10 patients undergoing c-CABG were enrolled. The levels of cytokines after r-CABG and c-CABG were compared using the mixed-effect linear regression model for longitudinal data. Cytokine release in the r-CABG group was comparatively less for IL-6, IL-10, tumor necrosis factor, and CRP levels. They all trended toward the baseline by the 48th hour in both groups, except CRP levels, which reached their peak at 48 hours in both groups. CONCLUSIONS The inflammatory response to r-CABG was blunted compared with that of c-CABG. The high CRP levels on the second postoperative day after r-CABG were a cause for concern in regard to percutaneous coronary intervention performed at that time period, but additional studies are necessary.
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Affiliation(s)
- Galina Leyvi
- Department of Anesthesia, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Kumar Vivek
- Department of Anesthesia, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Sankalp Sehgal
- Department of Anesthesia, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Adrienne Warrick
- Department of Anesthesia, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Kea Alexa Moncada
- Department of Anesthesia, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Nancy Shilian
- Department of Anesthesia, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Jonathan D Leff
- Department of Anesthesia, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Robert E Michler
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Joseph J DeRose
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
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Poveda JG, Silva GL, Silva PC, Nobre Â. Successful coronary surgical stenting: a new hybrid approach. Interact Cardiovasc Thorac Surg 2017; 24:290-292. [PMID: 27677872 DOI: 10.1093/icvts/ivw253] [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: 04/12/2016] [Accepted: 06/17/2016] [Indexed: 11/12/2022] Open
Abstract
Our goal is to introduce a new hybrid coronary revascularization concept-coronary surgical stenting. The procedure was performed on a 78-year old woman with severe, long and calcified involvement of the proximal left anterior descending artery, chronic total occlusion of the mid-left anterior descending artery and severe disease in the distal left anterior descending artery. An off-pump minimally invasive procedure was performed through the fifth intercostal space, including concurrent surgical placement of a drug-eluting stent in the distal left anterior descending artery, through the left anterior descending artery graft incision, associated with the left internal mammary artery to the mid-left anterior descending artery graft. This procedure resulted in successful revascularization of the left anterior descending artery in a patient with complex coronary disease.
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Affiliation(s)
- Javier G Poveda
- Department of Cardio-Thoracic Surgery, Santa Maria University Hospital, Lisbon, Portugal
| | - Gustavo L Silva
- Department of Cardiology, Santa Maria University Hospital, Lisbon, Portugal
| | - Pedro C Silva
- Department of Cardiology, Santa Maria University Hospital, Lisbon, Portugal
| | - Ângelo Nobre
- Department of Cardio-Thoracic Surgery, Santa Maria University Hospital, Lisbon, Portugal
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Abstract
PURPOSE OF REVIEW The most optimal revascularization strategy in patients with multivessel coronary artery disease is a subject of ongoing debate. Hybrid coronary revascularization (HCR) aims to combine the advantages of both percutaneous and surgical revascularization in a single strategy. This review provides a timely overview of the use, practice patterns, clinical outcomes and future perspectives of HCR. RECENT FINDINGS A number of technological advances in stent technology and minimal invasive surgical techniques have enabled the use of HCR, in which the left internal mammary artery is grafted to the left anterior descending artery followed or preceded by percutaneous coronary intervention of non-left anterior descending artery lesions. Currently, HCR is reserved for a highly selected patient population, representing less than 1% of the total coronary artery bypass grafting volume in the United States. Clinical outcomes from observational studies as well as a randomized feasibility trial show encouraging results. SUMMARY HCR shows promising clinical results in patients with multivessel disease and/or left main involvement. Engagement from interventional and surgical communities, and adequate patient selection based on local expertise, and data from randomized controlled trials are needed to establish a permanent role in the armamentarium for coronary revascularization.
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Kayatta MO, Halkos ME. Reviewing hybrid coronary revascularization: challenges, controversies and opportunities. Expert Rev Cardiovasc Ther 2016; 14:821-30. [PMID: 27042753 DOI: 10.1080/14779072.2016.1174576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Two main approaches to myocardial revascularization currently exist, coronary artery bypass and percutaneous coronary intervention. In patients with advanced coronary artery disease, coronary artery bypass surgery is associated with improved long term outcomes while percutaneous coronary intervention is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach. This new approach, hybrid coronary revascularization, has shown encouraging early results. Minimally invasive techniques for bypass surgery have played a large part of bringing this approach into contemporary practice.
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Affiliation(s)
- Michael O Kayatta
- a Division of Cardiothoracic Surgery , Emory University School of Medicine , Atlanta , GA , USA
| | - Michael E Halkos
- a Division of Cardiothoracic Surgery , Emory University School of Medicine , Atlanta , GA , USA
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Leyvi G, Schechter CB, Sehgal S, Greenberg MA, Snyder M, Forest S, Mais A, Wang N, DeLeo P, DeRose JJ. Comparison of Index Hospitalization Costs Between Robotic CABG and Conventional CABG: Implications for Hybrid Coronary Revascularization. J Cardiothorac Vasc Anesth 2015; 30:12-8. [PMID: 26597467 DOI: 10.1053/j.jvca.2015.07.031] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To compare the direct costs of the index hospitalization and 30-day morbidity and mortality incurred during robotic and conventional coronary artery bypass grafting at a single institution based on hospital clinical and financial records. DESIGN Retrospective study, propensity-matched groups with one-to-one nearest neighbor matching. SETTING University hospital, a tertiary care center. PARTICIPANTS Two thousand eighty-eight consecutive patients who underwent primary coronary artery bypass grafting (CABG) from January 2007 to March 2012. INTERVENTIONS One hundred forty-one matched pairs were created and analyzed. MEASUREMENTS AND MAIN RESULTS Robotic CABG was associated with a decrease in operative time (5.61±1.1 v 6.6±1.15 hours, p<0.001), a lower need for blood transfusion (12.8% v 22.6%, p = 0.04), a shorter length of stay (6 [4-9]) v 7 [5-11] days, p = 0.001), a shorter ICU stay (31 [24-49] hours v 52 [32-96.5] hours, p<0.001) and lower NY state complications composite rate (4.26% v 13.48%, p = 0.01). In spite of that, the cost of robotic procedures was not significantly different from matched conventional cases ($18,717.35 [11,316.1-34,550.6] versus $18,601 [13,137-50,194.75], p = 0.13), except 26 hybrid coronary revascularizations in which angioplasty was performed on the same admission (hybrid 25,311.1 [18,537.1-41,167.85] versus conventional 18,966.13 [13,337.75-56,021.75], p = 0.02). CONCLUSION Robotically assisted CABG does not increase the cost of the index hospitalization when compared to conventional CABG unless hybrid revascularization is performed on the same admission.
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Affiliation(s)
- Galina Leyvi
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY.
| | | | - Sankalp Sehgal
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY
| | | | - Max Snyder
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY
| | - Stephen Forest
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY
| | - Alec Mais
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, Bronx, NY
| | | | - Patrice DeLeo
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY
| | - Joseph J DeRose
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, NY
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Phan K, Wong S, Wang N, Phan S, Yan TD. Hybrid coronary revascularization versus coronary artery bypass surgery: Systematic review and meta-analysis. Int J Cardiol 2015; 179:484-8. [DOI: 10.1016/j.ijcard.2014.11.061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 11/05/2014] [Indexed: 10/24/2022]
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Gosev I, Leacche M. Hybrid coronary revascularization: the future of coronary artery bypass surgery or an unfulfilled promise? Circulation 2014; 130:869-71. [PMID: 25055813 DOI: 10.1161/circulationaha.114.011857] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Igor Gosev
- From the Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA
| | - Marzia Leacche
- From the Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA.
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