scholarly journals Hybrid Coronary Revascularization Versus Off‐Pump Coronary Artery Bypass Grafting: Comparative Effectiveness Analysis With Long‐Term Follow‐up

Author(s):  
Ali Hage ◽  
Vincenzo Giambruno ◽  
Philip Jones ◽  
Michael W. Chu ◽  
Stephanie Fox ◽  
...  
Author(s):  
Shahzad G. Raja ◽  
Umberto Benedetto ◽  
Dimple Chudasama ◽  
Siobhan Daley ◽  
Mubassher Husain ◽  
...  

Author(s):  
Shahzad G. Raja ◽  
Umberto Benedetto ◽  
Dimple Chudasama ◽  
Siobhan Daley ◽  
Mubassher Husain ◽  
...  

Objective Despite increasing recognition of the benefits of off-pump coronary artery bypass grafting (CABG), concerns persist regarding its impact on long-term mortality and freedom from reintervention. In this study, we assessed the impact of off-pump CABG on long-term outcomes. Methods From January 2002 to December 2002, a total of 307 consecutive patients who underwent isolated multivessel off-pump CABG at our institution were compared with a control group of 397 patients who underwent multivessel on-pump CABG during the same period. Perioperative data were prospectively collected and compared. In addition, univariate and risk-adjusted comparisons between the two groups were performed at 10 years. Results After adjusting for clinical covariates, off-pump CABG did not emerge as a significant independent predictor of long-term mortality [hazard ratio (HR), 0.91; 95% confidence interval (CI), 0.70–1.12], readmission to hospital for cardiac cause (HR, 0.96; 95% CI, 0.78–1.10), or the need for reintervention (HR, 0.93; 95% CI, 0.87–1.05). Conclusions At long-term follow-up, off-pump CABG remains a safe and effective myocardial revascularization strategy with no adverse impact on survival or freedom from reintervention.


Author(s):  
Thomas A. Vassiliades ◽  
Patrick D. Kilgo ◽  
John S. Douglas ◽  
Vasilis C. Babaliaros ◽  
Peter C. Block ◽  
...  

Objective Hybrid coronary revascularization is offered as an alternative strategy for patients with multivessel coronary artery disease (CAD). We present our experience and provide a comparative analysis to off-pump coronary artery bypass grafting (OPCAB). Methods Ninety-one patients with multivessel CAD underwent minimally invasive left internal mammary artery to left anterior descending grafting in combination with percutaneous coronary intervention of nonleft anterior descending targets (HYBRID). The primary end point of this study was major adverse cardiac and cerebrovascular events (MACCE), defined as death, stroke, and nonfatal myocardial infarction. MACCE in the HYBRID group were compared with 4175 contemporaneously performed OPCAB operations by logistic (30-day outcomes) and Cox proportional hazards (long-term survival) regression methods. Propensity scoring was used to adjust for potential selection bias. Results The 30-day MACCE (death/stroke/nonfatal myocardial infarction) rate was 1.1% for the HYBRID group (0%/0%/1.1%) and 3.0% for the OPCAB group (1.8%/1.1%/0.5%) (odds ratio = 0.47, P = 0.48). Angiographic left internal mammary artery evaluation was obtained in 95.6% of patients (87 of 91) revealing FitzGibbon A patency in 98.0% (96 of 98). The reintervention rate at 1 year for the HYBRID group was 5.5% (5 of 91) and was limited to repeat percutaneous coronary intervention. Three-year survival was statistically similar for the two groups (hazard ratio = 0.44, P = 0.18, see Kaplan-Meier figure). Conclusions Hybrid coronary revascularization may be noninferior to OPCAB with respect to early MACCE and 3-year survival in the treatment of multivessel CAD.


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