Background: Hybrid coronary revascularization (HCR) combines bypass grafting of the left anterior descending (LAD) coronary artery with percutaneous coronary intervention (PCI) of non-LAD vessels. HCR has been performed as an alternative to Coronary Artery Bypass Graft Surgery (CABG) or multi-vessel PCI.
Aim: To study the results of hybrid revascularization in patients with multi-vessel coronary artery disease amongst patients with stable coronary artery disease.
Materials and methods: Patients with multi-vessel coronary artery disease confirmed by coronary angiography were included in our prospective single-center study. Hybrid coronary revascularization (two-staged intervention) was performed as follows: in the first stage LIMA grafting to the LAD artery via left anterior mini thoracotomy (MIDCAB) was performed; in the second stage coronary artery stenting was performed within 1–3 days of admission. We used second-generation DES (Xience).
Study endpoints included successful intervention, death, myocardial infarction (MI), stroke, repeat revascularization, and bleeding. There was also combined endpoint which included death, MI, stroke (MACCE).
Results: From January 2014 to May 2015, 50 patients underwent HCR. The mean age was 62±7.4 years, and 39 patients (78%) were males. All patients showed a multi-vessel disease with a mean SYNTAX score of 24.1±5.0. The mean EuroScoreII was 1.2±0.76%.
Ten patients (20%) required conversion to conventional CABG. One patient (2%) had occlusion of the LIMA graft during the second stage (PCI) as shown by an angiographic examination. This patient underwent multi-vessel stenting, including repeat revascularization LAD. Hemorrhagic complication occurred in only one patient (2%), which requires surgical hemostasis and blood transfusion. There was one case (2%) MI-related (early stent thrombosis) death during postoperative period.
We performed analysis of 1-year follow-up. There were two cases (4%) of death during the 1-year period of follow-up. Two patients had occlusion of the LIMA graft as shown by an angiographic examination. These patients were performed repeat revascularization LAD. There was one case (2%) of stroke. During the 1-year period of follow-up MACCE rate was 8%.
Conclusion: Hybrid coronary revascularization is a promising technique that combines the advantages of the LIMA-to-LAD graft with the superior patency of DES on non-LAD vessels. The results of our trial show that hybrid coronary revascularization is feasible in select patients with multivessel coronary artery disease.