Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass

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Presentation transcript:

Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass Zachary N. Kon, BA, Emile N. Brown, BS, Richard Tran, BS, Ashish Joshi, MD, MPH, Barry Reicher, MD, Michael C. Grant, BS, Seeta Kallam, MD, Nicholas Burris, BS, Ingrid Connerney, PhD, David Zimrin, MD, Robert S. Poston, MD The Journal of Thoracic and Cardiovascular Surgery Volume 135, Issue 2, Pages 367-375 (February 2008) DOI: 10.1016/j.jtcvs.2007.09.025 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Although a significant increase in operative costs was noted in the hybrid group (P < .001), total average costs were not significantly different between the groups. This was the result of significantly lower postoperative costs (P < .001) in the hybrid group, with its reduction in transfusions and lengths of intensive care unit and hospital stay versus the off-pump coronary artery bypass grafting through a sternotomy (OPCAB) group. NS, Not significant. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 367-375DOI: (10.1016/j.jtcvs.2007.09.025) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 At 1 year, patients reported their overall satisfaction with the procedure on a 1- to 6-point scale, ranging from dissatisfied to completely satisfied. The hybrid group reported a significantly higher mean level of satisfaction compared with that of the off-pump coronary artery bypass grafting through a sternotomy (OPCAB) group, with 83% of patients in the hybrid group versus 42% of patients in the OPCAB group completely satisfied (P ≤ .001, Fisher exact test). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 367-375DOI: (10.1016/j.jtcvs.2007.09.025) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 The time for each patient to return to work (or normal activity for those who do not work) was monitored in each patient group. The period required for patients in the hybrid group was significantly shorter compared with that of the off-pump coronary artery bypass grafting through a sternotomy (OPCAB) group. After adjusting for potential confounders with a multivariate analysis, assignment to the hybrid group was found to be an independent predictor of a shorter length of time to return to work/normal activities (t = −2.5, P = .02). The Journal of Thoracic and Cardiovascular Surgery 2008 135, 367-375DOI: (10.1016/j.jtcvs.2007.09.025) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Myocardial ischemia, inflammation, and activation of coagulation were analyzed within the heart after hybrid versus off-pump coronary artery bypass grafting through a sternotomy (OPCAB) procedures by obtaining aortic and coronary sinus blood samples 30 minutes after case completion. The transcardiac gradients of serum levels of markers of thrombin formation (prothrombin fragment 1.2 [F1.2]), activation of the intrinsic coagulation cascade (activated Factor XII [FXII-a]), ischemia (myoglobin), and inflammation (interleukin 8 [IL-8]) were all significantly reduced after the hybrid procedure versus OPCAB. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 367-375DOI: (10.1016/j.jtcvs.2007.09.025) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 An analysis of early graft and stent patency was obtained by using multichannel computed tomographic angiography before discharge and again at 1 year. This analysis showed a trend toward better midterm target-vessel patency for the hybrid group. Both groups received 100% follow-up at both time points. OPCAB, Off-pump coronary artery bypass grafting through a sternotomy; NS, not significant. The Journal of Thoracic and Cardiovascular Surgery 2008 135, 367-375DOI: (10.1016/j.jtcvs.2007.09.025) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions