Guan Zhiyuan, Zhang Zhe, Gu Kaiyun, Wang Heqing, Lin Jin, Zhou Wenjun, Wan Feng
Department of Cardiology Surgery, Peking University Third Hospital, Haidian District, Beijing, China.
Heart Surg Forum. 2019 Dec 20;22(6):E493-E502. doi: 10.1532/hsf.2499.
Minimally invasive coronary revascularization (MICR) involves minimally invasive direct coronary artery bypass grafting (MIDCAB) and robotic-assisted coronary artery bypass grafting (RCABG), and hybrid coronary revascularization (HCR) aims to combine MICR/RCABG on left anterior descending (LAD) and percutaneous coronary interventions (PCI) on non-LAD lesions. We performed a systematic review and metaanalysis to compare clinical outcome after MICR and HCR.
A metaanalysis was carried out through searching PubMed, EMBASE, Web of Science, and Medline for comparative studies evaluating the primary and secondary clinical end points.
A systematic literature search identified 8 observational studies that satisfied our inclusion criteria, including being suitable for metaanalysis; the studies were between 1990 and 2018 and included 1084 cases of HCR and 2349 cases of MICR. Metaanalysis of these studies showed that HCR was associated with a reduced need for ICU LOS (WMD -11.46 hours, 95% CI, -18.76 ~ -4.25, P = .02), to hospital time (WMD -1.34 hours, 95% CI, -2.42 to 0.26, P < .01), and blood transfusion (OR 0.43, 95% CI, 0.31-0.59, P < .00001) than MICR. Comparisons of individual components showed no significant difference in terms of in-hospital mortality, MACCE, shock, myocardial infarction (MI), long-term survival, total variable cost, and surgical complications (including renal failure, chest drainage, bleeding).
HCR was noninferior to MICR in terms of in-hospital mortality, MACCE, shock, MI, long-term survival, total variable cost, and surgical complications (including renal failure, chest drainage, bleeding), whereas HCR was associated with a reduced need for ICU LOS, hospital time, and blood transfusion than MICR and less infection than MICR. Further randomized studies are warranted to corroborate these observational data.
微创冠状动脉血运重建术（MICR）包括微创直接冠状动脉旁路移植术（MIDCAB）和机器人辅助冠状动脉旁路移植术（RCABG），而杂交冠状动脉血运重建术（HCR）旨在将左前降支（LAD）的MICR/RCABG与非LAD病变的经皮冠状动脉介入治疗（PCI）相结合。我们进行了一项系统评价和荟萃分析，以比较MICR和HCR后的临床结局。
通过检索PubMed、EMBASE、科学网和Medline进行荟萃分析，以评估评估主要和次要临床终点的比较研究。
一项系统文献检索确定了8项符合我们纳入标准的观察性研究，包括适合进行荟萃分析的研究；这些研究时间在1990年至2018年之间，包括1084例HCR病例和2349例MICR病例。对这些研究的荟萃分析表明，与MICR相比，HCR减少了对重症监护病房住院时间（加权均数差-11.46小时，95%可信区间，-18.76~-4.25，P=0.02）、住院时间（加权均数差-1.34小时，95%可信区间，-2.42至0.26，P<0.01）和输血（比值比0.43，95%可信区间，0.31-0.59，P<0.00001）的需求。各组成部分的比较显示，在院内死亡率、主要不良心血管和脑血管事件（MACCE）、休克、心肌梗死（MI）、长期生存率、总可变成本和手术并发症（包括肾衰竭、胸腔引流、出血）方面无显著差异。
在院内死亡率、MACCE、休克、MI、长期生存率、总可变成本和手术并发症（包括肾衰竭、胸腔引流、出血）方面，HCR不劣于MICR，而与MICR相比，HCR减少了对重症监护病房住院时间、住院时间和输血的需求，且感染少于MICR。需要进一步的随机研究来证实这些观察数据。
