Hybrid coronary revascularization (HCR) versus coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD): A meta-analysis of 14 studies comprising 4226 patients
Sanjana Nagraj MBBS
Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, New York, USA
Search for more papers by this authorAndreas Tzoumas MD
University of Cincinnati Medical Center, Cincinnati, Ohio, USA
Search for more papers by this authorFotis Kakargias MD
Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Search for more papers by this authorStefanos Giannopoulos MD
Division of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
Search for more papers by this authorAthina Ntoumaziou MD
General Hospital of Filiates, Filiates, Greece
Search for more papers by this authorDamianos G. Kokkinidis MD, MSc
Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
Search for more papers by this authorMiguel Alvarez Villela MD
Division of Cardiology, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, New York, USA
Search for more papers by this authorCorresponding Author
Azeem Latib MD
Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, New York, USA
Correspondence Azeem Latib, MD, Interventional Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 1825 Eastchester Rd, Bronx, NY 10461, USA.
Email: [email protected]
Search for more papers by this authorSanjana Nagraj MBBS
Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, New York, USA
Search for more papers by this authorAndreas Tzoumas MD
University of Cincinnati Medical Center, Cincinnati, Ohio, USA
Search for more papers by this authorFotis Kakargias MD
Department of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
Search for more papers by this authorStefanos Giannopoulos MD
Division of Cardiology, Rocky Mountain Regional VA Medical Center, Aurora, Colorado, USA
Search for more papers by this authorAthina Ntoumaziou MD
General Hospital of Filiates, Filiates, Greece
Search for more papers by this authorDamianos G. Kokkinidis MD, MSc
Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, Connecticut, USA
Search for more papers by this authorMiguel Alvarez Villela MD
Division of Cardiology, Jacobi Medical Center/Albert Einstein College of Medicine, The Bronx, New York, USA
Search for more papers by this authorCorresponding Author
Azeem Latib MD
Department of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, New York City, New York, USA
Correspondence Azeem Latib, MD, Interventional Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, 1825 Eastchester Rd, Bronx, NY 10461, USA.
Email: [email protected]
Search for more papers by this authorSanjana Nagraj and Andreas Tzoumas contributed equally to this work.
Abstract
Objectives
To compare the outcomes of hybrid coronary revascularization (HCR) with traditional coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD).
Background
HCR has emerged as an alternative to CABG in patients with MVCAD. Through minimally invasive surgical techniques, HCR carries the potential for faster recovery postoperatively, fewer complications, and lower utilization of resources.
Methods
Systematic search of electronic databases was conducted up to December 2021 and studies comparing HCR with CABG in the treatment of MVCAD were included in this meta-analysis. Primary outcomes of interest were incidence of 5-year mortality and major adverse cardiac and cerebral event (MACCE).
Results
Fourteen studies (12 observational studies and 2 randomized controlled trials) comprising 4226 patients were included. The rates of 5-year mortality (odds ratios [OR]: 1.55; 95% confidence interval [CI]: 0.92−2.62; I2 = 83.0%) and long-term MACCE (OR: 0.97; 95% CI: 0.47−2.01; I2 = 74.7%) were comparable between HCR and CABG groups. HCR was associated with a significantly lower likelihood of perioperative blood transfusion (OR: 0.36; 95% CI: 0.25−0.51; I2 = 55.9%), shorter mean hospital stay (weighted mean difference: −2.04; 95% CI: −2.60 to −1.47; I2 = 54%), and risk of postoperative acute kidney injury (OR: 0.45; 95% CI: 0.23−0.88; p = 0.02). CABG demonstrated a lower likelihood of requiring long-term repeat revascularization (OR: 1.51; 95% CI: 1.03−2.20; I2 = 18%) over a follow-up duration of 29.14 ± 21.75 months.
Conclusion
This meta-analysis suggests that HCR is feasible and safe for the treatment of MVCAD. However, benefits of HCR should be carefully weighed against the increased long-term risk of repeat-revascularization when selecting patients, and further studies evaluating differences in long-term mortality between HCR and CABG are required.
CONFLICTS OF INTEREST
Azeem Latib, MD has served on Advisory Boards or as a consultant for Medtronic, Boston Scientific, Edwards Lifesciences, Abbott, and V-dyne. The remaining authors declare no conflict of interest.
Open Research
DATA AVAILABILITY STATEMENT
The data that supports the findings of this study are available in the supplementary material of this article.
Supporting Information
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| ccd30446-sup-0001-Supplementary_Tables_I_CCI_Revision_08_28.docx14.3 KB | Supporting information. |
| ccd30446-sup-0002-Supplementary_Table_II_CCI_revision_08_28.docx15.5 KB | Supporting information. |
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