The comparison of mid- and long-term follow-up between two-stage Hybrid coronary revascularization and off-pump coronary artery bypass for multi-vessel coronary artery disease

Objective To evaluate the mid- and long-term efficacy of Hybrid coronary revascularization (HCR) in the treatment of multi-vessel coronary artery disease for 5 years after operation, and to compare the operative effect with those of off-pump coronary artery bypass grafting (OPCABG) for the same period. Methods From March 2010 to June 2013, 37 patients underwent selective staging HCR surgery (HCR group) due to multi-vessel coronary artery disease in our hospital. All patients were treated by PCI and MIDCAB subsequently. 148 patients with OPCABG completed by the same group of doctors at the same time were served as control group (OPCABG group), and the follow-up period was up to June 2018. The end point of the study was the incidence of major adverse cardiac or cerebrovascular events (MACCE) events in both groups, including cardiac death, new myocardial infarction, secondary coronary revascularization and cerebrovascular accident. Results The clinical baseline data of the two groups were basically matched. 37 patients in HCR group were successfully operated on, and each patient was completed with LIMA-LAD bypass, 72 drug-eluting stents were implanted. 504 stents were bridged in 148 patients in OPCABG group, each patient was completed with LIMA-LAD bypass, the other target vessels were performed by sequential anastomosis with great saphenous vein as graft. The average follow-up time was 6.3 years (5.1-8.2 years). In HCR group, 33 patients(89%)completed the follow-up, of which 6 (18%) had MACCE events. In OPCABG group, 130 patients(88%)successfully completed the follow-up, of which 19 (15%) had MACCE events. There was no significant difference in MACCE-free survival rate between the two groups (HCR 81.8% vs. OPCABG 73.8%, P>0.05). Conclusion The mid- and long-term effect of HCR is similar to that of OPCABG in the treatment of multi-vessel coronary artery disease, but it has the advantages of less traumatic, faster recovery and less use of blood products. It can be widely used in patients with selective multi-vessel coronary artery disease. Key words: Coronary artery disease; Hybrid coronary revascularization; Minimally invasive direct coronary artery bypass