title: Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass.
abstract: OBJECTIVE
  Less-invasive options are available for surgical treatment of multivessel coronary artery disease. We hypothesized that stenting combined with grafting of the left anterior descending artery with the left internal thoracic artery through a minithoracotomy (hybrid procedure) would provide the best outcome.
  
  
  METHODS
  Patients with equivalent numbers of coronary lesions (2.8 +/- 0.4) underwent either hybrid (n = 15) or off-pump coronary artery bypass through a sternotomy (n = 30). Early and 1-year outcomes were compared. Blood drawn from the aorta and coronary sinus immediately postoperatively was analyzed for activation of coagulation (prothrombin fragment 1.2 and activated Factor XII), myocardial injury (myoglobin), and inflammation (interleukin 8) by using an enzyme-linked immunosorbent assay. Target-vessel patency was determined by means of computed tomographic angiographic analysis.
  
  
  RESULTS
  The hybrid procedure was associated with significantly shorter lengths of intubation and stays in the intensive care unit and hospital and perioperative morbidity (P < .05). Intraoperative costs were increased but postoperative costs were reduced for the hybrid procedure compared with off-pump coronary artery bypass through a sternotomy. As a result, overall total costs were not significantly different between the groups. After adjusting for potential confounders, assignment to the hybrid group was an independent predictor of shortened time to return to work (t = -2.12, P = .04). Patient satisfaction after the hybrid procedure, as judged on a 6-point scale, was greater versus that after off-pump coronary artery bypass through a sternotomy. Finally, the hybrid procedure showed significantly reduced transcardiac gradients of markers of coagulation, myocardial injury, and inflammation and a trend toward significant improvement in target-vessel patency.
  
  
  CONCLUSIONS
  Perhaps because of reduced myocardial injury, inflammation, and activation of coagulation, patients undergoing the hybrid procedure had better perioperative outcomes and satisfaction, with excellent patency at 1 year's follow-up. These promising preliminary findings warrant further investigation of this procedure.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, University of Maryland Medical System, Baltimore, MD 21201, USA.
authors.forename: Zachary N
authors.initials: ZN
authors.lastname: Kon
authors.forename: Emile N
authors.initials: EN
authors.lastname: Brown
authors.forename: Richard
authors.initials: R
authors.lastname: Tran
authors.forename: Ashish
authors.initials: A
authors.lastname: Joshi
authors.forename: Barry
authors.initials: B
authors.lastname: Reicher
authors.forename: Michael C
authors.initials: MC
authors.lastname: Grant
authors.forename: Seeta
authors.initials: S
authors.lastname: Kallam
authors.forename: Nicholas
authors.initials: N
authors.lastname: Burris
authors.forename: Ingrid
authors.initials: I
authors.lastname: Connerney
authors.forename: David
authors.initials: D
authors.lastname: Zimrin
authors.forename: Robert S
authors.initials: RS
authors.lastname: Poston
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016022:Case-Control Studies; D015331:Cohort Studies; D017023:Coronary Angiography; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods* / Q000401:mortality; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007387:Internal Mammary-Coronary Artery Anastomosis / Q000379:methods* / Q000401:mortality; D007902:Length of Stay / Q000639:trends; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000503:physiopathology; D010865:Pilot Projects; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014654:Vascular Patency