Hybrid options for treating cardiac disease

Hybrid coronary revascularization versus off-pump coronary artery bypass grafting and percutaneous coronary intervention for the treatment of two-vessel coronary artery disease with proximal left anterior descending artery stenosis

Background

This study sought to compare clinical outcomes of hybrid coronary revascularization (HCR) with off-pump coronary artery bypass grafting (OPCAB) and percutaneous coronary intervention (PCI) for the treatment of two-vessel coronary artery disease (CAD) including proximal LAD stenosis.

Methods

From January 2009 to December 2016, 52 patients of two-vessel CAD including proximal LAD stenosis underwent HCR at Rui Jin Hospital. Using propensity score methodology, these patients were matched with those in the OPCAB and PCI cohorts. The primary endpoint during follow-up was main adverse cardiovascular and cerebrovascular events (MACCE).

Results

The intensive care unit (ICU) length of stay (LOS) and the hospital LOS were shorter in the HCR group than in the OPCAB group (ICU LOS: P<0.001; hospital LOS: P=0.027). The mean follow-up time was 59 months (interquartile range, 42 to 79 months). The 8-year freedom from MACCE of the HCR group was higher than that of the PCI group (P=0.008), but similar to that of the OPCAB group (P=0.893).

Conclusions

HCR provides favorable outcomes for selected patients with two-vessel CAD including proximal LAD stenosis.

Outcomes of a Combined Approach of Percutaneous Coronary Revascularization and Cardiac Valve Surgery

A subset of patients requiring coronary revascularization and valve surgery may benefit from a combined approach of percutaneous coronary intervention (PCI) and valve surgery, as opposed to the standard median sternotomy approach of combined coronary artery bypass and valve surgery. To evaluate its potential benefits and limitations, a literature search was performed using PubMed, EMBASE, Ovid, and the Cochrane library, through March 2016 to identify all studies involving a combined approach of PCI and valve surgery in patients with coronary artery and valvular disease. There were five studies included in the study with a total of 324 patients, of which 75 (23.1%) had a history of previous cardiac surgery. The interval between PCI and surgery ranged from simultaneous intervention to a median of 38 days (interquartile range, 18-65 days). The surgical approach performed consisted of a minimally invasive one or median sternotomy. There were 275 single valve surgery (84.9%) and 49 double-valve surgery (15.1%) with a 30-day mortality ranging from 0% to 5.5%. The 1-year survival ranged from 78% to 96%, and the follow-up period ranged from 1.3 to 5 years. Herein, we present a review of the literature using this technique.

Hybrid coronary revascularization: a systematic review

The hybrid approach to coronary revascularization is an evolving technique that is being used as an alternative to the traditional median sternotomy coronary artery bypass graft surgery. It combines a minimally invasive approach to bypass the left anterior descending coronary artery with a percutaneous approach to revascularize the other coronary arteries. A systematic review of the available literature was conducted to evaluate the benefits, and the short- and long-term outcomes of this procedure.

Concurrent Coronary Artery and Valvular Heart Disease - Hybrid Treatment Strategies in 2013

Concomitant coronary artery disease (CAD) and valvular heart disease is an increasingly common problem in the ageing population. Hybrid procedures combine surgical and transcatheter approaches to facilitate minimally invasive surgery or to transform a single high-risk open surgery into two less risky procedures. In ideal circumstances, this strategy may decrease the surgical risk in elderly, high-risk and reoperative surgical candidates, while improving patient comfort, convenience and cost-effectiveness. Hybrid procedures can be performed in a staged fashion or as a 'one-stop' procedure in a hybrid operating suite. Increasing evidence supports the safety and short-term efficacy of hybrid valve repair or replacement and coronary revascularisation procedures. Nevertheless, important questions remain, including the optimal timing of the individual procedures and the optimal antiplatelet therapy after percutaneous coronary intervention. With ongoing advances in procedural techniques and anticoagulation strategies, as well as the accumulation of long-term outcomes data, hybrid approaches to concomitant CAD and valvular heart disease will likely become increasingly common.

Combining PCI and CABG: the role of hybrid revascularization

Hybrid coronary revascularization combines the benefits of both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the treatment of multivessel coronary artery disease (CAD) by combining the benefits of the LIMA-to-LAD graft and drug eluting stent (DES) to non-LAD regions. Through this approach, a patient receives the long-term benefit of the LIMA graft and avoids the morbidity of a full sternotomy and saphenous vein grafts. Available data related to outcomes following hybrid revascularization is limited to small studies. In this review we seek to provide an overview of hybrid revascularization in the era of modern drug eluting stent technology, discuss appropriate patient selection, and comment on future trial design. Additionally, we review the recent literature pertaining to the hybrid approach.