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1-year follow-up of hybrid coronary revascularization for multi-vessel coronary artery disease amongst patients with stable coronary artery disease.

Session Poster session 1

Speaker Nikita Kochergin

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : N Kochergin (Kemerovo,RU), A Shilov (Kemerovo,RU), V Ganyukov (Kemerovo,RU)

Authors:
N. Kochergin1 , A. Shilov1 , V. Ganyukov1 , 1Research Institute for Complex Issues of Cardiovascular Diseases - Kemerovo - Russian Federation ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 198

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.

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