Practice Patterns and Clinical Outcomes after Hybrid Coronary Revascularization in the United States: An Analysis From the Society of Thoracic Surgeons Adult Cardiac Database
Background—Hybrid coronary revascularization (HCR) involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional coronary bypass surgery (CABG).
Methods and Results—Patients were included who underwent HCR (staged/concurrent) or isolated CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2011-March 2013). HCR represented 0.48% (n=950; staged=809, concurrent=141) of the total CABG volume (n=198,622) during the study period, and was performed in one-third of participating centers (n=361). Patients who underwent HCR had higher cardiovascular risk profiles compared with patients undergoing CABG. Compared with CABG, median sternotomy (98.5% for CABG, 61.1% for staged-HCR, and 52.5% for concurrent-HCR), direct vision harvesting (98.9%, 66.0% and 68.1%) and cardiopulmonary bypass (83.4%, 45% and 36.9%) were less frequently used for staged and concurrent HCR, while robotic assistance (0.7%, 33.0% and 30.5%) was more common. After adjustment, no differences were observed for the composite of in-hospital mortality and major morbidity (odds ratio (OR): 0.93, 95%-CI: 0.75-1.16, p=0.53 for staged-HCR, and OR: 0.94, 95%-CI:0.56-1.56, p=0.80 for concurrent-HCR compared with CABG). There was no statistically significant association between operative mortality and either treatment group (OR: 0.74, 95%-CI: 0.42-1.30, p=0.29 for staged-HCR, and OR: 2.26, 95%-CI:0.99-5.17, p=0.053 for concurrent-HCR compared with CABG).
Conclusions—HCR, either as a staged or concurrent procedure, is performed in one-third of U.S. hospitals and reserved for a highly selected patient population. Although HCR may appear to be an equally safe alternative for CABG surgery, further randomized study is warranted.
- hybrid coronary revascularization
- coronary artery bypass graft surgery
- coronary disease
- percutaneous coronary intervention
- drug-eluting stent
- off-pump surgery
- Received February 13, 2014.
- Revision received April 30, 2014.
- Accepted June 20, 2014.