Comparison of Surgical Outcomes and Long-Term Follow-Up in One-Stage Versus Two-Stage Hybrid Coronary Revascularization With DES

Abstract

Objective:

To compare perioperative outcomes in patients who receive complete revascularization in one-stage or two-stage hybrid coronary revascularization (HCR) with initial angioplasty.

Methods:

The research is a retrospective subanalysis of the HYBRID-COR feasibility study. Thirty patients who underwent one-stage HCR (endoscopic atraumatic coronary artery bypass grafting [EACAB] and percutaneous coronary intervention [PCI]; group 1) were compared with 121 patients who underwent EACAB procedure as a final stage of HCR (group 2). Observations of bleeding, transfusion requirements, kidney injury, and other complications were conducted. Long-term outcomes were evaluated.

Results:

Median (interquartile range [IQR]) perioperative drainage was higher in group 1 (750.0 [422.5 to 1,112.5] mL vs 400.0 [252.5 to 650.0] mL, P = 0.004), as was mechanical ventilation time (430.0 [300.0 to 600.0] min vs 300.0 [225.0 to 410.0] min, P = 0.001). Patients in group 1 required pleurocentesis more often (36.7% vs 13.2%, P = 0.003), as well as blood transfusions (26.7% vs 9%, P = 0.009). No significant differences were found for kidney injury incidence (20% vs 14.9%, P = 0.493). Two deaths (1.6%) and 1 myocardial infarction (0.8%) were noted in group 2 in the perioperative period. In a median long-term follow-up of 1,378.5 (758.0 to 2,033.0) days, no significant differences were noted in major adverse cardiac and cerebrovascular events, mortality, myocardial infarction occurrence, repeat revascularization, or incidence of stroke.

Conclusions:

PCI-first HCR is associated with less postoperative drainage, shorter mechanical ventilation time, fewer pleurocenteses, and less transfusion requirements when compared with one-stage HCR. The heart team decision is essential in choosing individual strategy, as the risk of postponing complete revascularization and temporary dual antiplatelet therapy withdrawal must be evaluated. Further studies are required, particularly on long-term outcomes.

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