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Review Article   

The Journal of Cardiovascular Surgery 2022 Mar 28

DOI: 10.23736/S0021-9509.22.12163-4

Copyright © 2022 EDIZIONI MINERVA MEDICA

lingua: Inglese

Hybrid revascularization vs coronary bypass for coronary artery disease: a systematic review and meta-analysis

David E. HINOJOSA-GONZALEZ 1, Luis C. BUENO-GUTIERREZ 1, Marcelo SALAN-GOMEZ 1, Eduardo TELLEZ-GARCIA 1, Isabela RAMIREZ-MULHERN 1, Diego SEPULVEDA-GONZALEZ 1, Diego RAMONFAUR 2, Andres ROBLESGIL-MEDRANO 1, Eduardo FLORES-VILLALBA 1, 3, 4

1 Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo León, México; 2 Division of Postgraduate Education, Harvard Medical School, Boston, MA, USA; 3 Tecnologico de Monterrey, Escuela de Ingenieria y Ciencias, Monterrey, Nuevo León, México; 4 Laboratorio Nacional de Manufactura Aditiva y Digital (MADIT), Apodaca, Nuevo León, México



INTRODUCTION: Coronary artery bypass graft is the mainstay of treatment for multivessel coronary artery disease and is superior to percutaneous coronary intervention. Combined approaches such as hybrid coronary revascularization integrate coronary artery bypass grafting with percutaneous coronary intervention during the same procedure or weeks apart. These attempt to improve surgical morbidity and long-term outcomes.
EVIDENCE ACQUISITION: Per PRISMA criteria, a systematic review of keywords “Hybrid revascularization”, “Hybrid Coronary Revascularization”, “Surgical”, “Surgery”, “Treatment”, “CABG”, “HCR” and “PCI” was conducted in PubMed, EMBASE and SCOPUS. Studies comparing this technique's performance on either single or two-stage approach against traditional multiple vessel coronary artery bypass grafting were screened and analyzed for our review.
EVIDENCE SYNTHESIS: Twenty-two studies totaling 6,981 participants were ultimately included for analysis. Mean differences in operative time, bleeding, ventilator time and length of stay were significantly lower in the hybrid coronary revascularization group. Odds ratios in transfusions and in-hospital myocardial infarction were also lower in the hybrid coronary revascularization group. Results for in-hospital and all-cause mortality, major adverse cardiac events (MACE), stroke, reintervention, and complete revascularization were not significantly different.
CONCLUSIONS: Our analysis shows hybrid coronary revascularization is a feasible alternative to traditional coronary artery bypass grafting. Short-and long-term outcomes including mortality, MACE, and postoperative morbidity are similar between both groups, while hybrid approaches are associated with decreased perioperative morbidity.


KEY WORDS: Coronary artery disease; Myocardial revascularization; Coronary artery bypass; Minimally invasive; Hybrid revascularization

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