Division of Cardiac Surgery Department of Surgery Western University London Health Sciences Centre London Ontario Canada.
Department of Anesthesia and Perioperative Medicine Western University London Health Sciences Centre London Ontario Canada.
J Am Heart Assoc. 2019 Dec 17;8(24):e014204. doi: 10.1161/JAHA.119.014204. Epub 2019 Dec 12.
Background Hybrid coronary revascularization (HCR) involves the integration of coronary artery bypass grafting (CABG) and percutaneous coronary intervention to treat multivessel coronary artery disease. Our objective was to perform a comparative analysis with long-term follow-up between HCR and conventional off-pump CABG. Methods and Results We compared all double off-pump CABG (n=216) and HCR (n=147; robotic-assisted minimally invasive direct CABG of the left internal thoracic artery to the left anterior descending artery and percutaneous coronary intervention to one of the non-left anterior descending vessels) performed at a single institution between March 2004 and November 2015. To adjust for the selection bias of receiving either off-pump CABG or HCR, we performed a propensity score analysis using inverse-probability weighting. Both groups had similar results in terms of re-exploration for bleeding, perioperative myocardial infarction, stroke, blood transfusion, in-hospital mortality, and intensive care unit length of stay. HCR was associated with a higher in-hospital reintervention rate (CABG 0% versus HCR 3.4%; =0.03), lower prolonged mechanical ventilation (>24 hours) rate (4% versus 0.7%; =0.02), and shorter hospital length of stay (8.1±5.8 versus 4.5±2.1 days; <0.001). After a median follow-up of 81 (48-113) months for the off-pump CABG and 96 (53-115) months for HCR, the HCR group of patients had a trend toward improved survival (85% versus 96%; =0.054). Freedom from any form of revascularization was similar between the 2 groups (92% versus 91%; =0.80). Freedom from angina was better in the HCR group (73% versus 90%; <0.001). Conclusions HCR seems to provide, in selected patients, a shorter postoperative recovery, with similar excellent short- and long-term outcomes when compared with standard off-pump CABG.
背景 杂交冠状动脉血运重建（HCR）涉及冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗的整合，用于治疗多支冠状动脉疾病。我们的目的是对 HCR 与常规非体外循环 CABG 进行长期随访的比较分析。
方法和结果 我们比较了 2004 年 3 月至 2015 年 11 月在单家机构进行的所有双非体外循环 CABG（n=216）和 HCR（n=147；机器人辅助微创直接左内乳动脉至左前降支 CABG 和经皮冠状动脉介入治疗非左前降支血管中的一支）。为了调整接受非体外循环 CABG 或 HCR 的选择偏倚，我们使用逆概率加权进行倾向评分分析。两组在因出血再次探查、围手术期心肌梗死、卒中和输血、住院死亡率和重症监护病房住院时间方面均有相似的结果。HCR 与更高的院内再介入率（CABG 0%与 HCR 3.4%；=0.03）、更低的长时间机械通气率（>24 小时）（4%与 0.7%；=0.02）和更短的住院时间（8.1±5.8 天与 4.5±2.1 天；<0.001）相关。非体外循环 CABG 的中位随访时间为 81（48-113）个月，HCR 为 96（53-115）个月。在中位随访 81（48-113）个月后，HCR 组患者的生存率有改善趋势（85%与 96%；=0.054）。两组间任何形式的血运重建无差异（92%与 91%；=0.80）。HCR 组患者的心绞痛无复发率更好（73%与 90%；<0.001）。
结论 在选择的患者中，HCR 似乎提供了更短的术后恢复时间，与标准非体外循环 CABG 相比，具有相似的优异短期和长期结果。
