Author + information
- Mark R. Vesely,
- Eric Lehr,
- Nikolaos Bonaros,
- Thomas Schachner,
- Guy Friedrich,
- Markus Kofler,
- Mukta Srivastava,
- David Zimrin and
- Johannes Bonatti
Hybrid Coronary Revascularization (HCR) couples surgical bypass and percutaneous coronary intervention (PCI) techniques, allowing complete coronary revascularization with a minimally invasive approach. Short and long term outcomes appear similar to multi–vessel open coronary bypass surgery while also associated with decreased recovery time. Ability to predict well suited patients for this approach has not been previously evaluated.
From 10/2001 to 6/2012, 277 patients (age 61 (31–90), 75% male, BMI 28 (14–60)) underwent HCR on an intention to treat basis. Single (158), double (102), or triple (17) coronary bypass grafting was completed in endoscopic fashion with robotic assistance using daVinci® surgical tele–manipulation systems. 173 patients had definitive HCR, 23 were converted to full CABG by open sternotomy and 81 patients completed surgery and deferred PCI. PCI included placement of drug eluting stents (118), bare metal stents (41), balloon angioplasty (6) or thrombo–aspiration (3).
Over a 5 year follow up interval (mean 23 months), freedom from MACCE was 83%. MACCE events included death (4.3%), myocardial infarction (2.8%), stroke (1.8%), and repeat revascularization by CABG (1.8%) or PCI (5.0%). Kaplan–Meier survival analysis demonstrated age ≥80 (p<0.001), pre–operative creatinine >2.0 (p<0.001), history of vasculopathy (p=0.002), STS risk score >2.0% (p<0.001), and EuroSCORE >5 (p<0.001) to be associated with an increased rate of MACCE events. Factors not associated with MACCE events included sex, BMI, smoking, diabetes, hypertension, COPD, LVEF, prior MI, and prior PCI.
These observational data suggest patients already at elevated surgical risk are also at long–term risk of subsequent adverse events following planned HCR, as might also be expected with open sternotomy CABG or multi–vessel PCI. Patients with generalized vasculopathy and chronic kidney disease need special attention during patient selection.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.–4:30 p.m.
Session Title: Multivessel Disease
Abstract Category: 45. TCT@ACC–i2: Coronary Intervention, Multivessel disease
Presentation Number: 2104–260
- 2013 American College of Cardiology Foundation