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Long-Term Survival in Triple-Vessel Disease: Hybrid Coronary Revascularization Compared to Contemporary Revascularization Methods
  • +7
  • Craig Basman,
  • Jonathan Hemli,
  • Michael Kim,
  • Karthik Seetharam,
  • Derek Brinster,
  • Luigi Pirelli,
  • Chad Kliger,
  • S Scheinerman,
  • Varinder Singh,
  • Nirav Patel
Craig Basman
Lenox Hill Hospital
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Jonathan Hemli
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Michael Kim
Lenox Hill Hospital
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Karthik Seetharam
Lenox Hill Hospital
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Derek Brinster
Lenox Hill Hospital
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Luigi Pirelli
Lenox Hill Hospital
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Chad Kliger
Lenox Hill Hospital
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S Scheinerman
Lenox Hill Hospital
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Varinder Singh
Lenox Hill Hospital
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Nirav Patel
Lenox Hill Hospital
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Peer review status:Published

05 Jun 2020Submitted to Journal of Cardiac Surgery
06 Jun 2020Assigned to Editor
06 Jun 2020Submission Checks Completed
24 Jun 2020Reviewer(s) Assigned
05 Jul 2020Review(s) Completed, Editorial Evaluation Pending
15 Jul 2020Editorial Decision: Accept
28 Jul 2020Published in Journal of Cardiac Surgery. 10.1111/jocs.14891

Abstract

Background: Hybrid coronary revascularization (HCR) constitutes a left internal mammary artery (LIMA) graft to the left anterior descending (LAD) coronary artery, coupled with percutaneous coronary intervention (PCI) for non-LAD lesions. This management strategy is not commonly offered to patients with complex multi-vessel disease. Our objective was to evaluate 8-year survival in patients with triple-vessel disease (TVD) treated by HCR, compared with that of concurrent matched patients managed by traditional coronary artery bypass grafting (CABG) or multi-vessel PCI. Methods: A retrospective review was undertaken of 4805 patients with TVD who presented between January 2009 and December 2016. A cohort of 100 patients who underwent HCR were propensity-matched with patients treated by CABG or multi-vessel PCI. The primary end-point was all-cause mortality at 8 years. Results: Patients with TVD who underwent HCR had similar 8-year mortality (5.0%) as did those with CABG (4.0%) or multi-vessel PCI (9.0%). A composite end-point of death, repeat revascularization, and new myocardial infarction, was not significantly different between patient groups (HCR 21.0% vs. CABG 15.0%, p = 0.36; HCR 21.0% vs. PCI 25.0%, p = 0.60). Despite a higher baseline SYNTAX score, HCR was able to achieve a lower residual SYNTAX score than multi-vessel PCI (p = 0.001). Conclusions: In select patients with TVD, long-term survival and freedom from major adverse cardiovascular events (MACE) after HCR are similar to that seen after traditional CABG or multi-vessel PCI. HCR should be considered for patients with multi-vessel disease, presuming a low residual SYNTAX score can be achieved.