Conventional Off-Pump Coronary Revascularization with Exclusive Bilateral Internal Mammary Arteries Versus Hybrid Coronary Revascularization, 10-Year Results

Background: Conventional off-pump total arterial revascularization with bilateral internal mammary arteries (BIMA) is known to offer one of the best results for coronary revascularization but with a higher risk for sternal wound complications. On the other hand, hybrid coronary revascularization (HCR) is a safe and less invasive strategy for achieving adequate coronary revascularization. Currently, long-term results of patients who are otherwise fit for surgery but have received hybrid revascularization are lacking. To optimize the choice of revascularization strategy for otherwise surgically fit patients, we decided to compare both strategies in a retrospective fashion. The primary focus of our comparative study is long-term survival and freedom from repeat revascularization.

Methods: Patients receiving conventional off pump revascularization with bilateral internal mammary arteries (n = 542) from 2002-2012 were historically compared in a retrospective fashion with patients receiving hybrid revascularization (n = 123) from 2002–2020 at our institute. A 1:2 propensity score match was used to adjust for baseline confounders. After propensity matching, early postoperative results as well as long-term survival and the need for repeat revascularization were examined.

Results: The median age in years of patients receiving HCR was higher (72 vs. 63, p < 0.001) than that of BIMA patients, with a higher incidence of chronic obstructive lung disease (12% vs. 5.4%, p = 0.006). On the other hand, patients receiving BIMA had a higher incidence of three-vessel coronary artery disease (49% vs. 63%, p = 0.05) as well as left main disease (11% vs. 25%, p < 0.001). These differences were adjusted for using 1:2 propensity score matching. No difference was found in early postoperative outcomes except for re-exploration for bleeding, which was higher in the HCR group (1.8% vs. 6.9%, p = 0.04). After propensity matching, 10-year survival as well as freedom from repeat revascularization were better in the BIMA arm (p < 0.001, p = 0.014, respectively).

Conclusion: For patients who are fit for surgery, conventional off pump revascularization with BIMA is associated with superior survival and freedom from repeat revascularization when compared to the hybrid strategy.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024