ObjectivesHybrid coronary revascularization (HCR) involves the use of minimally invasive direct coronary artery bypass grafting (CABG) to treat the left anterior descending artery (LAD), and percutaneous coronary intervention to treat non-LAD vessels. We reported the results of a comparative analysis between HCR and off-pump CABG via sternotomy (OPCABG).MethodsData were retrospectively collated from patients who underwent HCR or OPCABG for multivessel coronary artery disease between 2011 and 2022. Propensity score-based matching was performed to reduce the selection bias. The Comparisons of cardiac-related death, major adverse cardiac and cerebrovascular events (MACCE), and repeat revascularization were performed by Kaplan-Meier analysis or the Fine-Gray test.ResultsAfter matching, the baseline characteristics were well-balanced between the two groups with 91 patients per group. There was no significant difference in operative mortality rate (1.1% for HCR vs2.2% for OPCABG, p = 1.000). However, patients undergoing HCR required a significantly lower rate of blood product transfusions ( p < .001) and experienced significantly fewer pulmonary complications than OPCABG patients ( p < .001). At 10 years, the incidences of cardiac-related death, MACCE and repeat revascularization did not differ significantly between the two groups (9.5% vs11.5%, p = .277; 4.7% vs12.3%, p = .361; 1.2% vs2.5%, p = .914, respectively).ConclusionsFor patients with multi-vessel lesions, HCR was comparable to OPCABG in long-term outcomes such as cardiac-related death, MACCE, and the durability of grafts. Additionally, HCR was better than OPCABG in perioperative outcomes. HCR may be an alternative therapy for OPCABG in patients with multi-vessel coronary artery disease.

中文翻译：

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比较混合冠状动脉血运重建术与开放式冠状动脉搭桥术治疗多支血管病变患者的临床结果

目的混合冠状动脉血运重建（HCR）涉及使用微创直接冠状动脉旁路移植术（CABG）治疗左前降支（LAD），并使用经皮冠状动脉介入治疗非LAD血管。我们报告了 HCR 与经胸骨切开术的非体外循环 CABG (OPCABG) 的比较分析结果。方法回顾性整理了 2011 年至 2022 年间因多支冠状动脉疾病接受 HCR 或 OPCABG 的患者的数据。减少选择偏差。采用Kaplan-Meier分析或Fine-Gray检验进行心脏相关死亡、主要不良心脑血管事件（MACCE）、再次血运重建的比较。结果匹配后，两组基线特征均衡。每组 91 名患者。手术死亡率没有显着差异（HCR 为 1.1%，OPCABG 为 2.2%，p = 1.000）。然而，与 OPCABG 患者相比，接受 HCR 的患者需要的血液制品输注率显着较低 (p < .001)，并且肺部并发症明显较少 (p < .001)。10 年时，两组之间心脏相关死亡、MACCE 和重复血运重建的发生率没有显着差异（9.5% vs11.5%，p = 0.277；4.7% vs12.3%，p = 0.361；1.2） % vs2.5%，p = .914，分别）。结论对于多支血管病变的患者，HCR 在长期结局（如心脏相关死亡、MACCE 和移植物耐久性）方面与 OPCABG 相当。此外，HCR 的围手术期结局优于 OPCABG。HCR 可能是多支冠状动脉疾病患者 OPCABG 的替代疗法。