Author + information
- Alberto Repossini1,
- Maurizio Tespili2,
- Antonio Saino2,
- Igor Kotelnikov1,
- Annalisa Moggi1,
- Lorenzo Di Bacco1 and
- Claudio Muneretto1
Hybrid Coronary Revascularization, meaning Left Mammary Artery on Left Anterior Descending (MIDCAB) combined with non-LAD PCI stenting, is considered as a viable alternative to conventional CABG through sternotomy or to multi-vessel PCI, in order to perform a functionally complete revascularization. We report our results and mid-term outcomes of this therapeutic strategy.
Since January 2009 up to October 2012, 70 consecutive patients underwent hybrid revascularization after Heart Team evaluation. Coronary risk was assessed by SYNTAX score, and patients were partitioned in tertiles according to the score categories (≤22 low risk, >22 and ≤33 intermediate risk, >33 high risk). Pre-operative risk assessment was upgraded to EuroSCORE II for all patients. Long-term outcomes, major adverse cardiac and cerebrovascular events (MACCE) rate and repeated target vessels revascularization (TVR) rate were evaluated by Kaplan-Meier curve and log-rank test.
Mean age was 66.3 ± 12.0 years and 83.8% of patients were males. Mean SYNTAX score was 28,22 ± 7 (mean SYNTAX score in patients with Left main involved 33,5 ± 4,5). Mean EuroSCORE II was 4,05 ± 1,83. PCI was performed in all patients (n=70), in 52 pts (75,2%) before MIDCAB and in 24,8% of cases after surgery (interval 2,2 ± 1,3 months). In 12 patients (18,6%) Left Main was involved and MIDCAB was performed prior to PCI. No intra-operative or in-hospital deaths were reported. At follow-up one cardiac death for acute inferior myocardial infarction occurred. Two patients with Left Main needed a repeated non-LAD revascularization: one case for an acute myocardial infarction and the other due to recurrent angina with in-stent restenosis at angiography. At 25 ± 13 months follow-up the overall population freedom from MACCEs rate was 82,6% (CI: 79,5% to 85,7%) and the freedom from TVRs rate was 86,1% (CI: 82,9% to 89,3%). Despite the rate of MACCE and TVR was higher in patients with intermediate and high coronary risk than in patients with SYNTAX score ≤ 22, however such difference was not statistically significant (p > 0,05).
Hybrid Coronary Revascularization is a viable option to perform a minimally invasive functionally complete revascularization in high risk patient that can't undergo conventional revascularization. However this strategy has better results when performed on patients with a SYNTAX score ≤ 22. In our experience patients with Left Main HCR had a good outcome at the end of revascularization, although being burdened by an high TVR rate.
- 2013 American College of Cardiology Foundation