Department of Cardiothoracic Surgery, University of Chicago Medicine, IL USA.
Department of Cardiology, University of Chicago Medicine, IL USA.
Innovations (Phila). 2022 Nov-Dec;17(6):513-520. doi: 10.1177/15569845221137349. Epub 2022 Dec 18.
Hybrid coronary revascularization (HCR) is the integration of sternal-sparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with multivessel coronary artery disease (CAD). It is traditionally performed with single-vessel bypass (left internal mammary artery [LIMA] to left anterior descending artery [LAD]) and PCI but can also be accomplished with multiple arterial grafts using bilateral IMA conduits. We sought to review our HCR experience over an 8-year period with robotic totally endoscopic coronary artery bypass (TECAB) and PCI.
Of 694 patients undergoing beating-heart TECAB from August 2013 to June 2022, 306 patients were designated as intention-to-treat HCR candidates. Patients underwent PCI prior to, the same day as, or following TECAB, performed using single or bilateral IMA grafts. We retrospectively reviewed early and midterm outcomes up to 8 years in this cohort of patients.
The mean Society of Thoracic Surgeons predicted risk of mortality was 1.5% ± 2.5%. There were 44 patients (14%) who had ≥70% left main disease and 218 patients (71%) who had triple-vessel disease. A total of 193 patients (63%) underwent multivessel grafting (advanced HCR), with 83% bilateral IMA use. Mean operative time was 263 ± 80 min, and mean length of stay was 2.6 days. The mean number of vessels bypassed per patient was 1.7 ± 0.6. The mean number of vessels stented was 1.2 ± 0.5. Of the patients, 84% underwent TECAB first, 14% PCI first, and 2% same-day TECAB/PCI. Mortality was 0.6% (observed to expected ratio: 0.42). Early graft patency was 97% (328 of 339 grafts); LIMA-LAD patency was 98%. At 8-year follow-up (mean 37 ± 26 months), all-cause and cardiac-related mortality were 13% and 2.6%, respectively. Freedom from major adverse cardiac and cerebrovascular events was 92%.
In patients with multivessel CAD, integrating robotic single and multivessel TECAB with PCI resulted in excellent early and midterm outcomes. In experienced hands, the robotic endoscopic approach allows the routine use of multiple arterial grafting during HCR.
杂交冠状动脉血运重建（HCR）是在多支冠状动脉疾病（CAD）患者中整合非体外循环冠状动脉旁路移植术（CABG）和经皮冠状动脉介入治疗（PCI）。传统上采用单血管旁路（左内乳动脉[LIMA]至左前降支[LAD]）和 PCI 完成，但也可以使用双侧IMA 导管完成多动脉移植。我们旨在回顾我们在 8 年期间使用机器人全内镜冠状动脉旁路移植术（TECAB）和 PCI 进行 HCR 的经验。
在 2013 年 8 月至 2022 年 6 月期间，有 694 例接受非体外循环跳动心脏 TECAB 的患者中，有 306 例被指定为意向性 HCR 候选者。患者在 TECAB 之前、同一天或之后进行 PCI，使用单支或双侧 IMA 移植物进行。我们对该队列患者的早期和中期结果进行了长达 8 年的回顾性研究。
平均胸外科医生协会预测死亡率为 1.5%±2.5%。有 44 例（14%）患者存在≥70%的左主干疾病，218 例（71%）患者存在三支血管疾病。共有 193 例（63%）患者接受了多血管移植（高级 HCR），其中 83%采用双侧 IMA 。平均手术时间为 263±80 分钟，平均住院时间为 2.6 天。每位患者旁路的平均血管数为 1.7±0.6。平均支架血管数为 1.2±0.5。其中，84%患者先接受 TECAB，14%患者先接受 PCI，2%患者同一天同时接受 TECAB/PCI。死亡率为 0.6%（观察到的预期比值：0.42）。早期移植物通畅率为 97%（328 个移植物中有 339 个）；LIMA-LAD 通畅率为 98%。在 8 年随访（平均 37±26 个月）时，全因死亡率和心源性死亡率分别为 13%和 2.6%。无主要心脏和脑血管不良事件发生率为 92%。
在多支 CAD 患者中，将机器人单支和多支 TECAB 与 PCI 相结合可获得出色的早期和中期结果。在有经验的医生手中，机器人内镜方法可在 HCR 期间常规使用多支动脉移植。
