Hybrid coronary revascularization versus conventional coronary artery bypass surgery: Utilization and comparative outcomes

Edward L. Hannan, Yifeng Wu, Kimberly Cozzens, Thoralf M. Sundt, Leonard Girardi, Joanna Chikwe, Andrew Wechsler, Craig R. Smith, Jeffrey P. Gold, Stephen J. Lahey, Desmond Jordan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

BACKGROUND: Hybrid coronary revascularization (HCR) treats multivessel coronary artery disease by combining a minimally invasive surgical approach to the left anterior descending artery with percutaneous coronary intervention for non-left anterior descending diseased coronary arteries. The objective of this study is to compare HCR and conventional coronary artery bypass graft (CABG) surgery medium-term outcomes. METHODS: Data from multivessel disease patients in New York's cardiac surgery and percutaneous coronary intervention registries in 2010 to 2016 were used to compare mortality and repeat revascularization rates for HCR and conventional CABG after using propensity matching to reduce selection bias. RESULTS: There was a total of 303 HCR (0.80%) patients and 37 556 conventional CABG patients after exclusions. After propensity matching, the respective median follow-up times were 3.72 years and 3.76 years. There was no difference between HCR and conventional CABG in survival at 6 years (80.9% versus 85.8%%, adjusted hazard ratio, 1.44 [0.90-2.31]), but HCR had higher mortality excluding deaths during the first year (adjusted hazard ratio, 1.88 [1.10-3.23]). Conventional CABG patients were more likely to be free from repeat revascularization at 6 years than HCR patients (88.2% versus 76.6%; hazard ratio, 2.22 [1.44-3.42]). CONCLUSIONS: HCR is rarely performed for patients with multivessel coronary artery disease. HCR and conventional CABG had no different 6-year mortality rates, but HCR had higher mortality after 1 year and higher rates of subsequent revascularization that were caused by both the need for repeat revascularization in the left anterior descending artery where minimally invasive CABG was performed, and in the coronary arteries where percutaneous coronary intervention was performed.

Original languageEnglish (US)
Article numbere009386
JournalCirculation: Cardiovascular Interventions
DOIs
StateAccepted/In press - 2020

Keywords

  • Coronary artery disease
  • Drug-eluting stent
  • Mammary arteries
  • Percutaneous coronary intervention
  • Selection bias

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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