Abstract 2464: “One Stop” Hybrid Percutaneous Coronary Intervention (PCI) with Coronary Artery Bypass Graft (CABG) vs. Standard CABG
Background: Recent studies suggested that PCI with drug eluting stents (DES) demonstrate better long term results than vein grafts while LIMA consistently outperformed other revascularization modes. Therefore, this study was undertaken to test if “one stop” hybrid PCI with CABG was feasible and safe as compared to standard CABG.
Methods and Results: We have developed one of the first hybrid cardiac catheterization and operating room in the USA. The facility allows us to perform “one stop” PCI and open heart surgery. Between April 2005–2006, 67 patients (mean age: 64±22, M/F: 39/28) underwent “one stop” PCI+CABG (hybrid group) while 136 (mean age: 62±18, M/F: 94/51) patients underwent standard CABG (standard group) with completion angiography. All patients in the hybrid group received LIMA-LAD with PCI to other vessels. Plavix was given immediately before the hybrid procedure. Baseline characteristics including gender, age, severity of CAD, renal function, hematocrits (HCT), platelet counts, cardiac biomarkers were similar in both groups. The hybrid group received 1.8±1.1 grafts/pt and 1.8±1.3 stents/pt while standard group received 2.4±2.2 grafts/pt. In the hybrid group, 87 vessels (1.3/pt) including 4% left main, 12% left anterior descending, 37% right coronary, 36% left circumflex, and 11% bypass grafts were stented (87% were DES). Post procedural bleeding complication, transfusions, HCT, platelet counts, cardiac markers, changes in renal function were similar in hybrid versus standard group. Aortic clamp time (56±21 vs. 65±34 min, p=0.05) is significantly shorter in the hybrid than standard group.
Conclusion: “One stop” hybrid PCI+CABG is feasible and safe. There was no increase in bleeding complication or rate of deterioration in renal function with “one stop” hybrid procedures as compared to standard CABG. Hybrid revascularization significantly shortens aortic clamp times that may reduce morbidities. Prospective randomized study to compare DES versus vein grafts in patients receiving LIMA-LAD is currently underway.