Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Comparison of Coronary Artery Bypass Graft-First and Percutaneous Coronary Intervention-First Approaches for 2-Stage Hybrid Coronary Revascularization

  • Choi, Hang Jun (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kang, Joonkyu (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Song, Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Do Yeon (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea) ;
  • Choi, Kuk Bin (Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • Received : 2016.08.29
  • Accepted : 2016.10.26
  • Published : 2017.08.05
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Abstract

Background: Hybrid coronary revascularization (HCR) was developed to combine the advantages of coronary artery bypass graft (CABG) with percutaneous coronary intervention (PCI). However, it is still controversial whether it is more optimal to perform CABG or PCI first. The purpose of this study was to compare the clinical outcomes of these 2 approaches. Methods: Eighty patients who underwent HCR from May 2010 to December 2015 were enrolled in this retrospective analysis. The CABG-first group comprised 12 patients and the PCI-first group comprised 68 patients. Outcomes of interest included in-hospital perioperative factors, major adverse cardiac and cerebrovascular events (MACCEs), and the incidence of repeated revascularization, especially for the target vessel lesion. Results: No significant difference was found in the amount of postoperative bleeding (p=0.239). The incidence of MACCEs was similar between the CABG-first and PCI-first groups (1 of 12 [8.3%] vs. 5 of 68 [7.4%], p>0.999). Repeated revascularization was performed on 3 patients (25%) in the CABG-first and 9 patients (13.2%) in the PCI-first group (p=0.376). Conclusion: There were no significant differences in postoperative and medium-term outcomes between the CABG-first and PCI-first groups. Based on these results, it can be inferred that it is safe to opt for either CABG or PCI as the primary procedure in 2-stage HCR.

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References

  1. Angelini GD, Wilde P, Salerno TA, Bosco G, Calafiore AM. Integrated left small thoracotomy and angioplasty for multivessel coronary artery revascularisation. Lancet 1996;347:757-8.
  2. Puskas JD, Halkos ME, DeRose JJ, et al. Hybrid coronary revascularization for the treatment of multivessel coronary artery disease: a multicenter observational study. J Am Coll Cardiol 2016;68:356-65. https://doi.org/10.1016/j.jacc.2016.05.032
  3. Fihn SD, Gardin JM, Abrams J, et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;60:e44-e164. https://doi.org/10.1016/j.jacc.2012.07.013
  4. Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS); European Association for Percutaneous Cardiovascular Interventions (EAPCI), Wijns W, et al. Guidelines on myocardial revascularization. Eur Heart J 2010;31:2501-55. https://doi.org/10.1093/eurheartj/ehq277
  5. Kang J, Song H, Lee SI, Moon MH, Kim HW, Jo GH. Hybrid coronary revascularization using limited incisional full sternotomy coronary artery bypass surgery in multivessel disease: early results. Korean J Thorac Cardiovasc Surg 2014;47:106-10. https://doi.org/10.5090/kjtcs.2014.47.2.106
  6. Hwang HY, Kim JH, Cho KR, Kim KB. Hybrid off-pump coronary artery bypass combined with percutaneous coronary intervention: indications and early results. Korean J Thorac Cardiovasc Surg 2005;38:733-8.
  7. Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery: survival data. Circulation 1983;68:939-50. https://doi.org/10.1161/01.CIR.68.5.939
  8. Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996;335:217-25. https://doi.org/10.1056/NEJM199607253350401
  9. BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J Am Coll Cardiol 2007;49:1600-6. https://doi.org/10.1016/j.jacc.2006.11.048
  10. Loop FD, Lytle BW, Cosgrove DM, et al. Influence of the internal-mammary-artery graft on 10-year survival and other cardiac events. N Engl J Med 1986;314:1-6. https://doi.org/10.1056/NEJM198601023140101
  11. Navarese EP, Tandjung K, Claessen B, et al. Safety and efficacy outcomes of first and second generation durable polymer drug eluting stents and biodegradable polymer biolimus eluting stents in clinical practice: comprehensive network meta-analysis. BMJ 2013;347:f6530. https://doi.org/10.1136/bmj.f6530
  12. Serruys PW, Morice MC, Kappetein AP, et al. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009;360:961-72. https://doi.org/10.1056/NEJMoa0804626
  13. Diegeler A, Thiele H, Falk V, et al. Comparison of stenting with minimally invasive bypass surgery for stenosis of the left anterior descending coronary artery. N Engl J Med 2002;347:561-6. https://doi.org/10.1056/NEJMoa013563
  14. Harskamp RE, Bonatti JO, Zhao DX, et al. Standardizing definitions for hybrid coronary revascularization. J Thorac Cardiovasc Surg 2014;147:556-60. https://doi.org/10.1016/j.jtcvs.2013.10.019
  15. Bonatti J, Schachner T, Bonaros N, et al. Technical challenges in totally endoscopic robotic coronary artery bypass grafting. J Thorac Cardiovasc Surg 2006;131:146-53. https://doi.org/10.1016/j.jtcvs.2005.07.064
  16. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the American Association for Thoracic Surgery, Society of Cardiovascular Anesthesiologists, and Society of Thoracic Surgeons. J Am Coll Cardiol 2011;58:e123-210. https://doi.org/10.1016/j.jacc.2011.08.009
  17. Panoulas VF, Colombo A, Margonato A, Maisano F. Hybrid coronary revascularization: promising, but yet to take off. J Am Coll Cardiol 2015;65:85-97. https://doi.org/10.1016/j.jacc.2014.04.093
  18. Repossini A, Tespili M, Saino A, et al. Hybrid revascularization in multivessel coronary artery disease. Eur J Cardiothorac Surg 2013;44:288-94. https://doi.org/10.1093/ejcts/ezt016
  19. Harskamp RE, Bagai A, Halkos ME, et al. Clinical outcomes after hybrid coronary revascularization versus coronary artery bypass surgery: a meta-analysis of 1,190 patients. Am Heart J 2014;167:585-92. https://doi.org/10.1016/j.ahj.2014.01.006

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