Hybrid coronary revascularization versus off-pump coronary artery bypass for the treatment of left main coronary stenosis

Abstract

Background: Coronary artery bypass grafting is standard of care for left main (LM) coronary artery stenosis. Hybrid coronary revascularization (HCR) is an alternative therapy, combining a minimally invasive, sternal-sparing, off-pump left internal mammary artery to left anterior descending coronary anastomosis with percutaneous coronary stent placement through the LM into the circumflex coronary artery.

Methods: From October 8, 2003, to April 23, 2010, 27 patients with LM coronary disease had HCR at a US academic center. These patients were matched 3:1 to 81 contemporaneous patients treated with off-pump coronary artery bypass grafting through a sternotomy by an optimal matching algorithm using seven preoperative variables. In-hospital major adverse cardiac and cerebrovascular events and repeat revascularization during the study period were compared between groups. All-cause mortality was compared using the National Social Security Death Index.

Results: Patency of the left internal mammary artery to left anterior descending coronary anastomosis was confirmed in all cases before LM stenting, which was successful in all patients. There was no perioperative death, stroke, or myocardial infarction among the HCR patients. Major adverse cardiac and cerebrovascular events were similar between groups. During a median of 3.2 years of follow-up, patients treated with HCR had a higher incidence of repeat revascularization than those treated with off-pump coronary artery bypass grafting (2 of 27, 7.4% versus 1 of 81, 1.2%; p = 0.09), but this was not statistically significant. The incidence of blood transfusion was higher with off-pump coronary artery bypass grafting (50 of 81, 61.7% versus 9 of 27 33.3%; p = 0.01).

Conclusions: Hybrid revascularization is a safe, feasible, and minimally invasive alternative to off-pump coronary artery bypass grafting for the treatment of LM coronary disease. Further investigation into the comparative effectiveness of this alternative strategy is warranted to identify optimal candidates for HCR.