Practice Patterns and Clinical Outcomes After Hybrid Coronary Revascularization in the United States

Authors:
  • JBJ. Matthew Brennan
    J. Matthew Brennan
  • YXYing Xian
    Ying Xian
  • MHMichael E. Halkos
    Michael E. Halkos
  • JPJohn D. Puskas
    John D. Puskas
  • VTVinod H. Thourani
    Vinod H. Thourani
  • JGJames S. Gammie
    James S. Gammie
  • BTBradley S. Taylor
    Bradley S. Taylor
  • RWRobbert J. de Winter
    Robbert J. de Winter
  • SKSunghee Kim
    Sunghee Kim
  • SOSean O’bRien
    Sean O’bRien
  • EPEric D. Peterson
    Eric D. Peterson
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Abstract
Background—: Hybrid coronary revascularization (HCR) involves a combination of surgical and percutaneous techniques, which in selected patients may present an alternative to conventional coronary artery bypass grafting (CABG). Methods and Results—: Patients were included who underwent HCR (staged/concurrent) or isolated CABG in the Society of Thoracic Surgeons Adult Cardiac Surgery Database (July 2011 to March 2013). HCR represented 0.48% (n=950; staged=809, concurrent=141) of the total CABG volume (n=198 622) during the study period, and was performed in one-third of participating centers (n=361). Patients who underwent HCR had higher cardiovascular risk profiles in comparison with patients undergoing CABG. In comparison with CABG, median sternotomy (98.5% for CABG, 61.1% for staged HCR, and 52.5% for concurrent HCR), direct vision harvesting (98.9%, 66.0%, and 68.1%) and cardiopulmonary bypass (83.4%, 45%, and 36.9%) were less frequently used for staged and concurrent HCR, whereas robotic assistance (0.7%, 33.0%, and 30.5%) was more common. After adjustment, no differences were observed for the composite of in-hospital mortality and major morbidity (odds ratio, 0.93; 95% confidence interval, 0.75–1.16; P =0.53 for staged HCR, and odds ratio, 0.94; 95% confidence interval, 0.56–1.56; P =0.80 for concurrent HCR in comparison with CABG). There was no statistically significant association between operative mortality and either treatment group (odds ratio, 0.74; 95% confidence interval, 0.42–1.30; P =0.29 for staged HCR, and odds ratio, 2.26; 95% confidence interval, 0.99–5.17; P =0.053 for concurrent HCR in comparison with CABG). Conclusion—: HCR, either as a staged or concurrent procedure, is performed in one-third of US hospitals and is reserved for a highly selected patient population. Although HCR may appear to be an equally safe alternative for CABG surgery, further randomized study is warranted.

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