Simultaneous Hybrid Revascularization Versus Off-Pump Coronary Artery Bypass for Multivessel Coronary Artery Disease

Background. This study sought to compare early and midterm clinical outcomes of a simultaneous hybrid coronary revascularization procedure with those in a propensity-matched subset of patients undergoing conventional off-pump coronary artery bypass grafting. Methods. From June 2007 through December 2009, 104 consecutive patients (mean age 61.8 +/- 10.2 years) with multivessel coronary artery disease underwent elective simultaneous coronary revascularization at Fuwai Hospital. Using propensity score methodology, these patients were matched with 104 patients who had undergone off-pump coronary artery bypass grafting through median sternotomy during the same period. We compared these groups' in-hospital clinical outcomes and freedom from major adverse cardiac or cerebrovascular events at a mean follow-up of 18 +/- 7.9 months. Results. The hybrid procedure required longer operative time and incurred higher in-hospital costs, but had shorter median intubation time (11.6 +/- 6.3 vs 13.8 +/- 6.8 hours, p = 0.02), intensive care unit length of stay (34.5 +/- 35.6 vs 55.3 +/- 46.4 hours, p < 0.001), and postoperative in-hospital length of stay (8.2 +/- 2.6 vs 9.5 +/- 4.5 days, p = 0.01). The hybrid group had significantly less chest tube drainage (789 +/- 389 vs 834 +/- 285 mL, p = 0.005) and need for blood transfusion (28.8% vs 51.9%, p > 0.001). At a mean follow-up of 18 months, the freedom from major adverse cardiac or cerebrovascular events is in favor of the hybrid group (99.0% vs 90.4%; p = 0.03). Conclusions. Compared with conventional off-pump coronary artery bypass grafting, simultaneous hybrid coronary revascularization shortens recovery time and has superior outcomes at a mean follow-up of 18 months. Simultaneous hybrid coronary revascularization provides a safe and reproducible alternative for selected patients with multivessel coronary artery diseases. (Ann Thorac Surg 2011;91:432-9) (C) 2011 by The Society of Thoracic Surgeons