Comparison of Hybrid Coronary Revascularization and Coronary Artery Bypass Grafting with Bilateral or Single Internal Mammary Artery Use.

Hoedemaker, N.P.G. (2014) Comparison of Hybrid Coronary Revascularization and Coronary Artery Bypass Grafting with Bilateral or Single Internal Mammary Artery Use. thesis, Medicine.

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Abstract

Background: Hybrid coronary revascularization (HCR) is a minimally invasive coronary revascularization strategy, which combines percutaneous coronary stenting with the durability of internal mammary artery bypass grafting to the left anterior descending artery. Recent studies have demonstrated safety and efficacy of HCR, however no single-institution direct comparisons to isolated CABG with single- or bilateral-internal mammary artery grafting (SIMA or BIMA, respectively) have been performed. Methods: Consecutive patients who underwent HCR or isolated CABG with either BIMA or SIMA use were included at a U.S. academic center between October 2003 and September 2013. Outcomes of interest were a composite of 30-day death, myocardial infarction and stroke (MACCE), 5-year all-cause mortality, and in-hospital complications and recovery parameters. Logistic regression and Cox-regression models were used to adjust for confounding for short-term and longitudinal outcomes, respectively. Results: Over the 10-year study period, 8,714 patients underwent coronary revascularization, with the majority being SIMA (7,742). Demographics were similar between groups, with a trend toward sicker patients in the SIMA group (23.7% heart failure vs. 12.2%, SIMA vs. HCR; Society of Thoracic Surgeons (STS) risk for morbidity/mortality 11.3, SIMA, vs. 8.9, HCR). SIMA and BIMA patients had higher percentage of three-vessel disease (72.3% and 74.9%, respectively), as compared to HCR patients (42.6%). Operative time was significantly shorter in the HCR group (279 minutes, vs 395 and 315 minutes, BIMA and SIMA, respectively, p<0.001). Cardiopulmonary bypass was not used in any HCR case, and sparingly in the BIMA (18.6%) and SIMA (32.8%) groups. Thirty-day MACCE and post-operative bleeding events were equivalent in all three groups, whereas in-hospital complications were significantly higher in the SIMA and BIMA groups as compared to the HCR group, primarily as a result of higher percentage of prolonged ventilation (>24h). When adjusted for STS short post-operative stay score, a significantly higher percentage of HCR patients had post-operative length of stay less than 5 days, compared to BIMA and SIMA patients. Cox-proportional modeling, adjusted for all parameters, at 5 years post-intervention showed no difference between HCR and SIMA for all-cause mortality (HR = 0.87). BIMA patients had a trend toward lower probability of mortality compared to HCR (HR = 1.46, p=0.15). Conclusion: HCR is a safe, minimally invasive alternative to traditional CABG and has an equivalent long-term mortality and short-term morbidity profile. Shorter operative times and post-operative length of stay suggests that cost may also be lower, however this needs to be studied directly.

Item Type:	Thesis (Thesis)
Supervisor name:	Koning-Mulder, W.A.H.
Supervisor name:	Harskamp, R.E. and Duke University Medical Center and and and Emory University School of Medicine
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:57
Last Modified:	25 Jun 2020 10:57
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1728

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