Hybrid total arterial minimally invasive off-pump coronary revascularization and percutaneous coronary intervention strategy for multivessel coronary artery disease: a cohort study with a median 11-year follow-up.

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiovascular diagnosis and therapy Pub Date : 2024-04-30 Epub Date: 2024-04-18 DOI:10.21037/cdt-23-413
Magdalena Rufa, Adrian Ursulescu, Ragi Nagib, Marc Albert, Ulrich F W Franke
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引用次数: 0

Abstract

Background: Hybrid coronary revascularization (HCR) is a treatment approach that combines the benefits of coronary artery bypass grafting (CABG) techniques such as minimally invasive direct coronary artery bypass (MIDCAB) or minimally invasive multivessel CABG (MICS-CABG) with percutaneous coronary intervention (PCI) for carefully selected patients with multivessel coronary artery disease (MV CAD). The extant body of research primarily concentrates on the comparison of outcomes between HCR and CABG or PCI. Furthermore, HCR is defined primarily as MIDCAB and PCI. Given the various criteria for HCR identified in the current body of literature, as well as several hybrid revascularization techniques, our primary goal was to analyse the characteristics and track the development of HCR patients operated on in our centre (Robert Bosch Hospital) over both short and long periods of time. Additionally, we sought to validate the practical challenges that arise during the implementation of an HCR methodology.

Methods: This cohort study included 138 patients with MV CAD who had an HCR approach in conjunction with isolated total arterial off-pump MICS-CABG or MIDCAB between 2007 and 2018 at Robert Bosch Hospital in Stuttgart. Data on major adverse cardiac and cerebral events (MACCE), defined as all-cause mortality, myocardial infarction, repeat revascularization and stroke were gathered through a questionnaire. Long-term follow-up, with a mean duration of 8.7±0.3 years and a median duration of 11 years, was available for a significant majority of the patients (92.8%, n=128).

Results: The average age was 69.6±11.2 years, with 79% being male. The mean European System for Cardiac Operative Risk Evaluation score I additive (EuroSCORE I) additive was 7.6±10.2 and the mean SYNergy between PCI with TAXUS and Cardiac Surgery (SYNTAX) Score I was 22.9±9.4. A total of 97 MIDCAB surgeries and 41 MICS-CABG procedures were performed without any instances of conversion to sternotomy or cardiopulmonary bypass (CPB). A total of 70 patients, or 50.7% of the sample, received the planned PCI treatment. This percentage was substantially lower in the subgroup with chronic CAD, with just 27, equivalent to 39.1%. The observed 30-day death rate was 2.1% (3/138). During follow-up, 3 myocardial infarctions, 18 PCI repeats, no CABG, and 4 strokes occurred. From 128 followed-up patients, 28 died (21.9%), 7 of which were heart deaths (5.5%). Total MACCE was 36.7%. The survival rates at 3 and 5 years were 92% and 85% respectively. Patients who didn't get the planned PCI had a mean survival rate of 6.8-9.1 years, while those with completed hybrid treatment had a higher mean survival rate of 8.4-10.2 years.

Conclusions: In selected individuals with MVCAD, current evidence suggests that HCR is a safe and effective coronary artery revascularization approach. After coronary bypass surgery, the attention going forward needs to be devoted toward the organization of the PCI step in the treatment process.

多支血管冠状动脉疾病的混合全动脉微创离泵冠状动脉血运重建和经皮冠状动脉介入治疗策略:一项中位随访 11 年的队列研究。
背景:混合冠状动脉血运重建(HCR)是一种治疗方法,它结合了冠状动脉旁路移植术(CABG)技术(如微创直接冠状动脉旁路移植术(MIDCAB)或微创多支血管CABG(MICS-CABG))和经皮冠状动脉介入治疗(PCI)的优点,适用于精心挑选的多支血管冠状动脉疾病(MV CAD)患者。现有研究主要集中于 HCR 与 CABG 或 PCI 的疗效比较。此外,HCR 主要被定义为 MIDCAB 和 PCI。鉴于现有文献中确定的 HCR 标准各不相同,而且有多种混合血管再通技术,我们的主要目标是分析在我们中心(罗伯特-博世医院)接受手术的 HCR 患者的特征,并跟踪其在短期和长期内的发展情况。此外,我们还试图验证在实施 HCR 方法过程中出现的实际挑战:这项队列研究纳入了斯图加特罗伯特博世医院在 2007 年至 2018 年期间采用 HCR 方法结合孤立全动脉离泵 MICS-CABG 或 MIDCAB 的 138 例中流 CAD 患者。通过问卷调查收集了主要不良心脑事件(MACCE)的数据,即全因死亡率、心肌梗死、重复血管重建和中风。对绝大多数患者(92.8%,n=128)进行了长期随访,平均随访时间(8.7±0.3)年,中位随访时间(11)年:平均年龄为(69.6±11.2)岁,79%为男性。欧洲心脏手术风险评估系统 I 级加分(EuroSCORE I)平均加分为 7.6±10.2,TAXUS PCI 和心脏手术(SYNTAX)I 级加分(SYNTAX)平均加分为 22.9±9.4。共进行了 97 例 MIDCAB 手术和 41 例 MICS-CABG 手术,无一例转为胸骨切开术或心肺旁路术(CPB)。共有 70 名患者(占样本的 50.7%)接受了计划的 PCI 治疗。在慢性 CAD 亚组中,这一比例要低得多,只有 27 例,相当于 39.1%。观察到的 30 天死亡率为 2.1%(3/138)。在随访期间,共发生了 3 例心肌梗死、18 例 PCI 重复治疗、无 CABG 和 4 例中风。128 名随访患者中有 28 人死亡(21.9%),其中 7 人死于心脏病(5.5%)。总MACCE为36.7%。3年和5年的存活率分别为92%和85%。未按计划接受PCI治疗的患者的平均生存率为6.8-9.1年,而完成混合治疗的患者的平均生存率更高,为8.4-10.2年:结论:对于选定的 MVCAD 患者,目前的证据表明 HCR 是一种安全有效的冠状动脉血运重建方法。在冠状动脉搭桥手术后,治疗过程中PCI步骤的组织需要引起重视。
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来源期刊
Cardiovascular diagnosis and therapy
Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine
CiteScore
4.90
自引率
4.20%
发文量
45
期刊介绍: The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.
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