Abstract 16531: Hybrid Coronary Revascularization is Associated with Improved Hospital Outcomes and Low Incidence of Death and Repeat Revascularization at Long-Term Follow-Up
Background: Hybrid coronary revascularization (HCR) is the planned use of minimally invasive LITA-LAD grafting with percutaneous coronary intervention (PCI) in the treatment of multivessel coronary artery disease. There are few long-term descriptions of MACCE related events that currently exist for a large cohort of HCR patients.
Methods: From January 2007 to May 2012, 54 patients undergoing HCR at a single institution were prospectively followed for a mean of 693 ± 556 days (2-1948). A robotic endoscopic atraumatic coronary artery bypass (endo-ACAB) technique was performed by a single surgeon in all cases. A retrospective review of our institutional database was performed. Survival data was collected from the social security death index.
Results: Mean age was 65.3 ± 10.7 yrs (40-85) and 44 (82%) were male. Comorbidities included DM (48%), COPD (13%), active smoking (22%), and cerebrovascular disease (24%). Mean STS risk score was 1.2 ± 1.3% (.2-6.6%). Pre-op EF was 57 ± 10.7%. 15 patients had robotic endo-ACAB 80 ± 77 days (3-251) after PCI, 34 had PCI 24 ± 59 (2-225) days after endo-ACAB, and 3 had a simultaneous procedure. A mean of 1.4 vessels/patient were treated with PCI (79 drug eluting and 13 bare metal stents). 29 patients were extubated in the operating room. Mean post-op ventilatory support was 10.5 ± 11.8 hrs. 9 (16.6%) patients required a blood transfusion (2 intra-op and 7 post-op). Major in hospital complications occurred in 5 patients including 2 prolonged intubations (> 24 hours), 1 reintubation,1 postpericardiotomy syndrome, and 1 arrhythmia requiring PPM implantation. 30 day mortality was 0%. Mean LOS was 6.6 ± 3.2 days and median LOS was 6 days. 50 patients were discharged home, 3 to rehab facilities, and 1 to a nursing home. Over the follow up period, there was 1 death at 33 months. 4 patients (7.4%) required repeat LAD revascularization (3 PCI, 1 re-op CABG). Repeat unplanned PCI to target vessels was required in 3 (5.5%) patients. No patients required repeat revascularization of non-target vessels.
Conclusion: HCR with robotic endo-ACAB provides excellent short term results with low in hospital morbidity and a high rate of return to home. Medium-term survival is high and need for repeat revascularization remains acceptable out to 5 year follow-up.
- © 2012 by American Heart Association, Inc.