Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA 30308, USA.
Ann Thorac Surg. 2011 Nov;92(5):1695-701; discussion 1701-2. doi: 10.1016/j.athoracsur.2011.05.090. Epub 2011 Sep 21.
Hybrid coronary revascularization (HCR) combines a minimally invasive (3-cm anterolateral thoracotomy), sternal-sparing, off-pump left internal mammary artery-left anterior descending (LIMA-LAD) coronary artery anastomosis with percutaneous coronary intervention (PCI) to non-LAD coronary arteries. We compared outcomes of HCR versus traditional off-pump coronary artery bypass grafting (OPCAB) for the treatment of multivessel coronary artery disease (CAD).
Between October 8, 2003 and April 23, 2010, 147 patients with multivessel coronary disease were treated with HCR at a US academic center. These were matched 4:1 to 588 contemporaneous patients treated with multivessel OPCAB by sternotomy using an optimal matching algorithm with 8 preoperative variables: age, gender, ejection fraction, presence of diabetes, myocardial infarction (MI), number of diseased vessels, left main coronary artery disease, and Society of Thoracic Surgeons (STS) predicted risk of mortality (PROM) score. In-hospital major adverse events (MACCE) and the need for repeated revascularization during follow-up were compared between groups. All-cause mortality was determined using the Social Security Death Index (SSDI).
Matching produced groups with similar coronary anatomy and statistically similar preoperative risk factors. The incidence of MACCE was similar between groups (3/147 HCR versus 12/588 OPCAB). During a median 3.2 years of follow up, the need for repeated revascularization was higher for HCR than for OPCAB (18/147 [12.2%] versus 22/588 [3.7%]; p < 0.001). The incidence of blood transfusion was higher for the OPCAB group. Estimated 5-year survival was similar between groups (OPCAB, 84.3% versus HCR, 86.8%; p = 0.61).
Hybrid coronary revascularization is a minimally invasive treatment for multivessel CAD. Although repeated revascularization was greater with HCR, both in-hospital and midterm outcomes were comparable with those of traditional OPCAB. Further investigation into the comparative effectiveness of this alternative strategy is warranted.
杂交冠状动脉血运重建（HCR）结合了微创（3cm 前外侧开胸术）、非体外循环（off-pump）、游离左内乳动脉-左前降支（LIMA-LAD）冠状动脉吻合术与经皮冠状动脉介入治疗（PCI）治疗非左前降支（LAD）冠状动脉。我们比较了 HCR 与传统非体外循环冠状动脉旁路移植术（OPCAB）治疗多支冠状动脉疾病（CAD）的结果。
2003 年 10 月 8 日至 2010 年 4 月 23 日，在美国一所学术中心，147 例多支冠状动脉疾病患者接受 HCR 治疗。通过最优匹配算法，使用 8 个术前变量（年龄、性别、射血分数、糖尿病、心肌梗死（MI）、病变血管数、左主干冠状动脉疾病和胸外科医师协会（STS）预测死亡率风险评分）与同期 588 例接受经胸骨切开术的多支 OPCAB 治疗的患者进行 4:1 匹配。比较两组患者住院期间主要不良心脏事件（MACCE）和随访期间再次血运重建的需要。使用社会保障死亡指数（SSDI）确定全因死亡率。
匹配产生了具有相似冠状动脉解剖结构和统计学上相似术前危险因素的两组患者。两组患者 MACCE 的发生率相似（HCR 组 3/147 例，OPCAB 组 12/588 例）。中位随访 3.2 年期间，HCR 组再次血运重建的需要高于 OPCAB 组（HCR 组 18/147 例[12.2%]，OPCAB 组 22/588 例[3.7%]；p<0.001）。OPCAB 组输血发生率较高。两组 5 年生存率相似（OPCAB 组 84.3%，HCR 组 86.8%；p=0.61）。
杂交冠状动脉血运重建是多支 CAD 的一种微创治疗方法。尽管 HCR 组再次血运重建的比例较高，但住院和中期结果与传统 OPCAB 相当。需要进一步研究这种替代策略的比较效果。
