Hybrid Coronary Revascularization: a Versatile and Effective Approach

Carlo Zebele, Luca S. De Santo, Emilio Mango, Leonardo Savarese, Tullio Tesorio, Luigi Salemme, Angelo Cioppa, Alessandro Nava, Francesco Iorio, Flora Numis

Clinica Montevergine, Avellino, Italy

Date, time and location: 2018.05.25 13:30, Congress Hall, 2F–A

Abstract

OBJECTIVES: Hybrid coronary revascularization (HCR) has been increasingly implemented with the aim of reaping the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach. To date, HCR has mainly been used in patient subsets with a specific indication for a combined procedure, such as challenges including limited conduit availability and predicted reduced healing after sternotomy or following primary PCI of a non-LAD culprit lesion. Consecutive series with well-defined inclusion criteria are scarce, and evidences from randomized studies are even fewer. The purpose of this study is to retrospectively evaluate the outcomes of this strategy in a single centre experience.

METHODS: Since December 2013 to December 2017 160 consecutive patients ( mean age 66.5±8.6, female 26.3%, diabetics 35%) underwent two-step (OPCABG first) HCR in a tertiary care centre. Indication to HCR was based on joint Heart Team evaluation of patients clinical and angiographic characteristics. This strategy was substantially implemented in three different settings: 1) minimally invasive direct left internal mammary artery to left anterior descending artery grafting (LIMA to LAD -LAST) (55 patients); 2) anaortic multivessel total arterial revascularization (35 patients); 3) limited conduit availability and or poor coronary targets for surgical approach (70 patients).

RESULTS: LIMA to LAD patency was 100% at pre stenting angiographic control. Mean hospital stay was 5±1.5, need for blood transfusions averaged 16%. There was no 30-day mortality, no periprocedural myocardial infarctions or stroke, nor reoperations for bleeding or wound dehiscence. Freedom from repeat myocardial revascularization was 98% at 1 year.

CONCLUSIONS: In selected recipients, HCR approach at inhospital and upto 1-year evaluation showed remarkable results even superior to those achieved by traditional approaches for myocardial revascularization