Comparative Study of Same Sitting Hybrid Coronary Artery Revascularization versus Off-Pump Coronary Artery Bypass in Multivessel Coronary Artery Disease

被引:85
作者
Bachinsky, William B.
Abdelsalam, Murad
Boga, Gouthami
Kiljanek, Lukasz
Mumtaz, Mubashir
Mccarty, Christine
机构
[1] Harrisburg Hosp, Pinnacle Hlth Cardiovasc Inst, Writing Grp, Cardiac Surg Grp, Harrisburg, PA USA
[2] Harrisburg Hosp, Pinnacle Hlth Cardiovasc Inst, Writing Grp, Intervent Cardiol Grp, Harrisburg, PA USA
关键词
FOLLOW-UP; SURGERY; TRIAL; INTERVENTION; GRAFTS;
D O I
10.1111/j.1540-8183.2012.00752.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: We compared the outcomes of same sitting robotic-assisted hybrid coronary artery revascularization (HCR) with off-pump coronary artery bypass grafting (OPCABG) in similar patients with multivessel coronary artery disease. Background: HCR is a novel procedure in selected patients with multivessel coronary artery disease (CAD). Although there are some data on staged HCR, the data on same sitting HCR are limited. Methods: We conducted a prospective study comparing same sitting robotic-assisted HCR patients (n = 25) to a group of consecutive low to moderate risk OPCABG patients (n = 27) during the study period. HCR patients underwent robotic internal mammary artery takedown followed by OPCABG via minithoracotomy. After confirming graft patency, immediate percutaneous coronary intervention on the nonbypass arteries was performed. Comparative analyses were performed on in-hospital and 30 day outcomes. Results: The baseline characteristics were similar for both groups including the severity of CAD (Syntax score 33.5+/-8.2 vs. 34.9+/-8.2, P = 0.556). Overall MACE was similar between both groups; however, the HCR group showed improved hospital outcomes with lower need for postoperative transfusions (12% vs. 67%, P < 0.001), and shorter length of hospital stay (5.1+/-2.8 vs. 8.2+/-5.4 days, P < 0.01). Despite lower postoperative costs, the HCR group had higher overall hospital costs due to higher procedural costs ($33,984 +/-$4,806 vs. $27,816+/-$11,172, P < 0.0001). Propensity model analysis showed similar findings. The HCR group showed improved quality of life measures with shorter time to return to work (5.3+/-3.0 vs. 8.2+/- 4.6 weeks, P = 0.01). Conclusions: Same sitting HCR appears to be feasible and may offer superior outcomes to standard OPCABG, further studies are warranted. (J Interven Cardiol 2012;25:460468)
引用
收藏
页码:460 / 468
页数:9
相关论文
共 22 条
[1]   Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation [J].
Angelini, GD ;
Wilde, P ;
Salerno, TA ;
Bosco, G ;
Calafiore, AM .
LANCET, 1996, 347 (9003) :757-758
[2]   Hybrid coronary revascularization - techniques and outcome [J].
Bonatti, J. ;
Lehr, E. J. ;
Vesely, M. ;
Friedrich, G. ;
Schachner, T. ;
Bonaros, N. ;
Griffith, B. ;
Zimrin, D. .
EUROPEAN SURGERY-ACTA CHIRURGICA AUSTRIACA, 2011, 43 (04) :198-204
[3]   A randomized comparison of radial-artery and saphenous-vein coronary bypass grafts [J].
Desai, ND ;
Cohen, EA ;
Naylor, CD ;
Fremes, SE .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 351 (22) :2302-2309
[4]   The Society of Thoracic Surgeons National Cardiac Surgery Database: Current risk assessment [J].
Edwards, FH ;
Grover, FL ;
Shroyer, LW ;
Schwartz, M ;
Bero, J .
ANNALS OF THORACIC SURGERY, 1997, 63 (03) :903-908
[5]  
Etienne PY, 2009, INNOVATIONS, V4, P340, DOI 10.1097/IMI.0b013e3181c49e8b
[6]  
Falk V, 2000, HEART SURG FORUM, V3, P29
[7]   CORONARY-BYPASS GRAFT FATE - ANGIOGRAPHIC GRADING OF 1400 CONSECUTIVE GRAFTS EARLY AFTER OPERATION AND OF 1132 AFTER ONE YEAR [J].
FITZGIBBON, GM ;
BURTON, JR ;
LEACH, AJ .
CIRCULATION, 1978, 57 (06) :1070-1074
[8]   Simultaneous Hybrid Revascularization Versus Off-Pump Coronary Artery Bypass for Multivessel Coronary Artery Disease [J].
Hu, Shengshou ;
Li, Qi ;
Gao, Peixian ;
Xiong, Hui ;
Zheng, Zhe ;
Li, Lihuan ;
Xu, Bo ;
Gao, Runlin .
ANNALS OF THORACIC SURGERY, 2011, 91 (02) :432-438
[9]   Comparison of coronary bypass surgery with drug-eluting stenting for the treatment of left main and/or three-vessel disease: 3-year follow-up of the SYNTAX trial [J].
Kappetein, Arie Pieter ;
Feldman, Ted E. ;
Mack, Michael J. ;
Morice, Marie-Claude ;
Holmes, David R. ;
Stahle, Elisabeth ;
Dawkins, Keith D. ;
Mohr, Friedrich W. ;
Serruys, Patrick W. ;
Colombo, Antonio .
EUROPEAN HEART JOURNAL, 2011, 32 (17) :2125-2134
[10]   2007 focused update of the ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention [J].
King, Spencer B., III ;
Smith, Sidney C., Jr. ;
Hirshfeld, John W., Jr. ;
Jacobs, Alice K. ;
Morrison, Douglass A. ;
Williams, David O. ;
Feldman, Ted E. ;
Kern, Morton J. ;
O'Neill, William W. ;
Schaff, Hartzell V. ;
Whitlow, Patrick L. ;
Adams, Cynthia D. ;
Anderson, Jeffrey L. ;
Buller, Christopher E. ;
Creager, Mark A. ;
Ettinger, Steven M. ;
Halperin, Jonathan L. ;
Hunt, Sharon A. ;
Krumholz, Harlan M. ;
Kushner, Frederick G. ;
Lytle, Bruce W. ;
Nishimura, Rick ;
Page, Richard L. ;
Riegel, Barbara ;
Tarkington, Lynn G. ;
Yancy, Clyde W. .
CIRCULATION, 2008, 117 (02) :261-295