Long-Term Follow-up of Hybrid Total Arterial Minimally Invasive Off-Pump Coronary Revascularization

 

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Background: Hybrid coronary revascularization (HCR) combines the strengths of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) for selected patients with multivessel coronary artery disease. HCR includes the minimally invasive direct coronary artery bypass (MIDCAB), or the minimally invasive multivessel coronary artery bypass grafting (MICS CABG) with PCI as staged hybrid procedures. This study evaluates the mid- and long-term follow-up results of these patients operated in our center.

Method: A consecutive series of 138 patients undergoing HCR between 2007 and 2018 was included. Via a left sided anterolateral minithoracotomy, the left internal thoracic artery (LITA) was used to graft the left anterior descending artery ± diagonal artery, while the lateral and/or posterior myocardial territories were grafted with a T-graft from LITA using radial artery endoscopically harvested. Patients received, as a staged procedure either before surgery or after, stenting of the remaining untreated territory with PCI. Major adverse cardiac and cerebral events (MACCE), freedom from angina and health status were collected by a questionnaire. Long-term follow-up (mean: 57.7 ± 29.7 months) was available for 121 patients (87.7%).

Results: Mean patient age was 69.6 ± 11.2 years. A total of 109 patients (79%) were male. 36.2% (50/138) had already underwent a PCI prior to surgery. 26.8% suffered an acute myocardial infarction within 3 weeks prior to surgery. The EuroSCORE II was 7.2 ± 10. There were 97 MIDCAB and 41 MICS CABG procedures with no conversions either to sternotomy or to cardio-pulmonary bypass. Average number of anastomosis performed were 1.31 ± 0.5. Average ICU and hospital stay was 1.5 ± 1.8 and 8.4 ± 4.2 days, respectively. Re-exploration was done in seven patients for bleeding. Six patients (4.3%) developed a wound infection necessitating reoperation, 3 (2.2%) suffered a stroke after surgery. The 30-day mortality was 2.9% (4/138). During follow-up, PCI was performed in 18 patients (13%). 3- and 5-year survival rate were 85% respectively 78%. At 3- and 5-year follow-up MACCE-free survival was 99% respectively 97%; freedom from angina rates were 90%, respectively 76%.

Conclusion: Current evidences suggest that HCR is a feasible, safe, and effective coronary artery revascularization strategy in selected patients with multivessel coronary artery disease. Survival and durability are comparable with conventional CABG with a low rate of complications.

Publication History

Article published online:
03 February 2022

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