Generalized Hybrid Coronary Revascularization Versus Conventional Off-Pump Coronary Artery Bypass Grafting for Multivessel Coronary Artery Disease

Zhang Shuai Li Ping Li Guang Yan Yunfeng Sun Tao Lin Ji Zhang Chenhao Liu Shuo Qu Zheng You Bin ^*

• Beijing Anzhen Hospital, Capital Medical University, Chaoyang District, China

Hybrid coronary revascularization (HCR) has been demonstrated as a safe and effective revascularization strategy in selected patients with multivessel coronary artery disease; however, the inclusion criteria are too strict.This study was conducted to compare in-hospital and midterm outcomes after generalized HCR and off-pump coronary artery bypass (OPCABG) in patients with multivessel coronary artery disease.We proposed a generalized idea of HCR. First, the PCI for non-LAD vessels suitable for coronary stents was performed. Then, MICS-CABG for LIMA to the LAD and saphenous to other non-LAD vessels that were not suitable for stents or stenting failed. Propensity score matching was used, and 222 patients (n=111 in both the generalized HCR and OPCABG groups) were enrolled in the study.The primary endpoint was a major adverse cardiac or cerebrovascular event (MACCE) over midterm follow-up, and the secondary endpoints were in-hospital outcomes.No significant difference was observed in the cumulative rate of MACCE (9.9% versus 16.2%; HR, 0.567; 95% CL, 0.268-1.201; P=0.138) between the generalized HCR and OPCABG groups. The residual SYNTAX score was similar between two groups (6.3 ± 5.5 for generalized HCR versus 6.8 ± 5.3 for OPCABG; P=0.486). Compared with OPCABG, generalized HCR was associated with a significantly lower intra-aortic balloon pump (IABP) implantation rate (2.7% versus 9.9%; P =0.027) and shorter postoperative length of stay (6.3±3.2 versus 7.7±3.0; P=0.001).The generalized HCR procedure appears to be safe and efficacious, with outcomes similar to those of standard off-pump CABG and satisfactory completeness of revascularization.